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At least 793 records · Page 44Linked to original sources
PubMed1987

Low-dose streptokinase thrombolysis of axillary-subclavian vein thrombosis.

Nine patients with 10 episodes of acute axillary-subclavian vein thrombosis were treated with local low-dose streptokinase infusion. All patients except one were heparinized during the procedure with conversion to oral anticoagulation upon completion of the infusion. Recanalization was achieved in 7 patients (70%). Thrombosis recurred in 1, and in 2 patients the procedure was unsuccessful. No major complications were encountered. We concluded that local low-dose streptokinase infusion is a safe, simple, and effective method for treating acute axillary-subclavian vein thrombosis.

Adult↗
PubMed2004

Hyperbaric oxygenation combined with streptokinase for treatment of arterial thromboembolism of the lower leg.

Thromboembolic occlusion of peripheral arteries is a common problem in patients referred to vascular surgery departments. Standard treatments include catheter aspiration techniques, use of fibrinolytic agents and surgical thrombendarterectomy. Recent reports have described the use of hyperbaric oxygen therapy in patients with limb ischemia, yet their main focus has been on patients with chronic disorders. We present the case of a 74-year-old woman with atrial fibrillation and acute thromboembolic occlusion of the posterior tibial artery. The patient presented with severe pain in the right calf, unresponsive to non-opioid parenteral analgesia and accompanied by coldness, numbness and partial motor palsy of the right foot. After 60 minutes of oxygenation in a hyperbaric chamber with a pressure of 2.2 bar, the pain receded, although without signs of restored blood flow in the occluded artery. After fibrinolytic therapy with streptokinase, patency of the posterior tibial artery was verified by return of palpable pulsations and color Doppler ultrasonography. By combining hyperbaric oxygenation and streptokinase in the treatment of lower-leg arterial thromboembolism we achieved regression of ischemic pain, prolongation of the survival time of tissues compromised by ischemia and resolved the cause of the ischemia. We believe the use of this therapeutic strategy in selected cases of peripheral arterial thromboembolism is justified.

Aged↗
PubMed2004

Renal fungal balls and pelvi-ureteric junction obstruction in a very low birth weight infant: treatment with streptokinase.

Renal candidiasis is a rare but well recognised complication of intensive care treatment in neonates. We report a problematic case with obstructing pelvi-ureteric junction (PUJ) fungal balls that was refractory to standard measures of adequate nephrostomy drainage, pelvic irrigation with amphotericin B, and systemic antifungal treatment. In an attempt to avoid potentially difficult open surgery, a novel treatment using a streptokinase solution (3,000 IU/ml) for irrigation was performed. This was successful in clearing the fungal balls, relieving obstruction and rendering the urine sterile. The present case highlights a potential role for streptokinase in cases of renal candidiasis refractory to current treatment protocols.

Antifungal Agents↗
PubMed1984

Intracoronary streptokinase in evolving acute myocardial infarction.

Intracoronary application of thrombolytic agents, particularly streptokinase, can recanalize arteries that had been totally occluded in patients with evolving acute myocardial infarction (AMI). Numerous uncontrolled trials have testified to the effectiveness of thrombolytic therapy in most patients in reestablishing flow to the infarct-related coronary artery. Follow-up of patients in whom reperfusion has been established has often demonstrated small but significant increases in the left ventricular ejection fraction. In contrast, in other patients in whom thrombolytic therapy failed to reopen the occluded vessel, the left ventricular ejection fraction usually does not change during follow-up. In most reported uncontrolled trials, few complications are described and the mortality rate in patients treated by this therapy may be lower than expected. These data have been used as the basis for widespread application of this technique in many catheterization laboratories around the world. Our initial experience at the University of Florida in 23 patients has not been as successful as other uncontrolled trials previously reported. Reperfusion was accomplished in only 12 patients. Of 17 who survived their AMI, only five demonstrated an improved left ventricular ejection fraction of at least 10%. Serious complications, including bleeding from catheterization sites or allergic reactions to streptokinase, occurred. Controlled trials to critically evaluate this new therapy are needed and are in progress.

Clinical Trials as Topic↗
PubMed1984

Role of coronary artery bypass surgery after intracoronary streptokinase infusion for myocardial infarction.

Intracoronary streptokinase infusion has been shown to improve left ventricular function and reduce hospital mortality in patients with acute myocardial infarction. Adjuvant coronary artery bypass surgery is of value in many of these patients who have recurrent angina, circulatory instability, severe coronary artery occlusive disease, or a high risk of reinfarction. There is little, if any, evidence that immediate coronary artery bypass surgery affects the results adversely--either because of recent myocardial infarction or recent streptokinase infusion, and early operation appears to be a safe and worthwhile modality of treatment in this group of patients with myocardial infarction.

Coronary Artery Bypass↗
PubMed1985

Long-term follow-up after intracoronary streptokinase therapy for acute myocardial infarction.

This article describes the effects on patients treated with intracoronary streptokinase during acute myocardial infarction and long-term follow-up. The mortality and the incidence of cardiac events were assessed during a follow-up period of 35 +/- 5 months. Coronary artery bypass grafting was undertaken in 37% of the patients. Hospital mortality was 11%, (n = 8); none of these deaths was due to myocardial rupture. The postdischarge mortality was 10%; three of these patients experienced sudden death. Serial assessment of left ventricular function in 35 patients showed an increase of angiographic ejection fraction prior to intervention from 50 +/- 4% to 58 +/- 12% (p = 0.005) 36 +/- 53 days later. Gated-blood pool imaging after 16 +/- 7 months (n = 35) and 32 +/- 9 months (n = 31) revealed no change in ejection fraction. Angina pectoris recurred in four of the 35 patients. We studied a historical comparison group, that consisted of 66 patients, who were treated at the same institution prior to the advent of intracoronary intervention techniques; this group was followed for 48 +/- 9 months. Baseline clinical and angiographic parameters were comparable in the two groups. Coronary artery bypass grafting was performed in only 18 of these patients. Mortality during hospitalization and postdischarge was not significantly different in the two groups. Ejection fraction decreased significantly in the comparison group from the first to the second evaluation and remained unchanged during the follow-up period. We conclude that no major adverse effects were associated with intracoronary streptokinase infusion over a long follow-up period. This may be related to the high frequency of coronary artery bypass surgery following reperfusion.

Aged↗
PubMed1987

Reperfusion with streptokinase of an occluded right coronary artery: effects on early and late right and left ventricular ejection fraction.

The effect of coronary artery recanalization on early and late right and left ventricular function was studied in patients with an acute inferior wall myocardial infarction caused by an occlusion of the right coronary artery. Fifty-four out of 138 patients, with chest pain lasting less than 4 hours, with ST elevations diagnostic for acute myocardial infarction not responding to medical treatment, and without contraindication for thrombolytic therapy, had an occluded right coronary artery. In 26 of these 54 patients, the occlusion was located proximal to the first right ventricular branch. Fourteen of them were treated conventionally (group A) and 12 with intracoronary streptokinase (group B). In 28 patients, the occlusion was distal to the first right ventricular branch. Fifteen were treated conventionally (group C) and 13 with intracoronary streptokinase (group D). In all patients, coronary angiograms were made 2 to 3 weeks after acute myocardial infarction. A nuclear angiogram was made the second day after admission and 3 months later to determine right and left ventricular ejection fraction. Values of radionuclide left and right ventricular ejection fraction (RVEF) between acute study (less than 48 hours after acute myocardial infarction [AMI]) and late study (3 months after AMI) showed no significant improvement in the four groups of patients studied. Group A patients (patients with total occlusion of the right coronary artery treated conventionally) had a significantly lower RVEF acutely and at late study as compared to the other three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Reduced infarct size in nonreperfused myocardial infarction by combined infusion of isosorbide dinitrate and streptokinase.

The value of thrombolytic therapy in myocardial infarction is well established, while any beneficial effect of adjunct therapy is more uncertain. In a double-blind, randomized, parallel-group study the effect of combined intravenous infusions of streptokinase and isosorbide dinitrate (ISDN) on enzyme-estimated infarct size was investigated. One hundred consecutive patients with strong clinical and electrocardiographic suspicion of myocardial infarction, admitted to the coronary care unit within 8 hours after the onset of symptoms, were given a streptokinase infusion of 1.5 million units for 1 hour and a titrated dose of ISDN or placebo for 48 hours. From isoenzyme B of creatine kinase (CK-B) values measured every 4 hours, the infarct size was calculated and the possible presence of reperfusion was evaluated. The infarct size in patients receiving ISDN infusion was reduced (p = 0.04, one-sided test) compared with placebo. By subdividing the patients according to whether or not reperfusion had occurred, the infarct size appeared to be similar following ISDN and placebo in patients with reperfusion (419 versus 369 U/L), whereas the infarct size in patients not reperfused was markedly reduced after treatment with ISDN (223 versus 1320 U/L, p = 0.003). In conclusion, the present study demonstrates that the infarct size may be reduced by other means than reperfusion and it supports the use of combined infusion of thrombolytic agents and nitrates in patients with suspected myocardial infarction.

Adult↗
PubMed1982

Effects of nonsurgical coronary reperfusion on the left ventricle in human subjects compared with conventional treatment. Study of 18 patients with acute myocardial infarction treated with intracoronary infusion of streptokinase.

Left ventricular function was assessed sequentially with biplane cineventriculography in 18 patients with acute myocardial infarction, in whom nonsurgical reperfusion was achieved within 8.2 +/- 6.9 hours (mean +/- standard deviation) after the onset of chest pain with intracoronary infusion of streptokinase (2,000 units/min for 66 +/- 16 minutes). Ejection fraction increased from 51.4 +/- 9.8 percent before reperfusion to 55.9 +/- 9.0 percent immediately after completion of streptokinase infusion (n = 13, p less than 0.01); the length of the akinetic myocardial segment decreased from 10.2 +/- 6.1 to 7.1 +/- 4.9 cm (p less than 0.025). Left ventricular function data before reperfusion and in the chronic stage of infarction (before surgery) were compared with data obtained in two medically treated groups that were matched retrospectively: control group I, nine patients with permanent obstruction of the infarcted vessel; control group II, nine patients with spontaneous recanalization of the initially obstructed vessel. In the acute stage of infarction, ejection fraction and akinetic segment length were comparable in the three groups. In the chronic stage ejection fraction was higher in the study group (57.4 +/- 12.7 percent) than in control group I (43.4 +/- 7.6 percent, probability [p] less than 0.05); the akinetic segment was shorter in the study group (4.5 +/- 6 versus 9.4 +/- 5.5 cm, p less than 0.025). Preservation of R waves was more extensive in the study group. Intraoperative inspection in 10 study group patients and transmural biopsy performed in 3 of these patients revealed the bulk of reperfused myocardium to be viable. It is concluded that jeopardized myocardium was preserved by nonsurgical reperfusion during the acute stage of coronary occlusion.

Aged↗
PubMed1988

Relation of coronary arterial patency and left ventricular function to electrocardiographic changes after streptokinase treatment during acute myocardial infarction.

One hundred and eighty-eight patients with evolving acute myocardial infarction were treated with intravenous streptokinase. Serial 12-lead electrocardiograms were recorded for 3 hours after treatment and inspected for rapid repolarization changes of the ST segment and T wave. Abrupt electrocardiographic repolarization changes were observed in 106 patients (56%) and were strongly predictive for an open infarct-related coronary artery at a mean of 6 days after treatment (predictive value = 0.92, sensitivity = 0.67). Abrupt electrocardiographic changes were not observed in 82 patients (44%). This absence was not a good predictor of an occluded infarct-related coronary artery (predictive value = 0.4). There was no relation between the presence or absence of abrupt electrocardiographic changes and global or regional left ventricular function after streptokinase treatment. Abrupt repolarization changes after thrombolytic treatment indicate a high probability of an open infarct-related artery. When abrupt repolarization changes do not occur, the patency of the infarct-related coronary artery cannot be predicted with accuracy. Serial electrocardiographic recordings do not provide sufficient information about coronary patency to eliminate the need for coronary arteriography.

Aged↗
PubMed1989

Pharmacokinetics, thrombolytic efficacy and hemorrhagic risk of different streptokinase regimens in heparin-treated acute myocardial infarction.

The systemic activator activity of 4 streptokinase (SK) regimens (250,000 IU intracoronary, group A; 500,000 IU, group B; 1.5 X 10(6) IU, group C; and 30 U anisoylated plasminogen streptokinase activator complex (APSAC) intravenously, group D) was tested with the fibrin plate technique. One hour after initiation of treatment, the activator activity was highest after APSAC (3.6 +/- 0.9 U), slightly but not significantly less after SK 1.5 X 10(6) IU (3.0 +/- 0.7), and significantly less after SK 500,000 IU (1.6 +/- 0.5) and 250,000 IU (0.6 +/- 0.5), p less than 0.001. After SK, activator activity half-lives were 184 minutes (group B) and 169 minutes (group C), and after APSAC 188 minutes (group D). These were all in agreement with greater than 12 hour duration of changes in other markers of systemic fibrinolysis (euglobulin lysis time) and substrates depletion (fibrinogen, plasminogen, alpha 2 antiplasmin). In extended pilot clinical groups given identical thrombolytic regimens during full anticoagulation with heparin, angiographic coronary patency was found in 83% (35 of 42) after intracoronary SK (group 1), in 73 and 75%, respectively, after 500,000 IU (31 of 43) and 1.5 X 10(6) IU (30 of 40) (group 2 and 3, difference not significant) and 80% (8 of 10) after the 30-U bolus of APSAC (group 4). The overall hemorrhagic risk was 24%, equally distributed among the 4 regimens and mostly (91%) related to catheters. The incidence of bleeding unrelated to vessel puncture was 4%; no deaths occurred. It is concluded that APSAC is the most fibrinolytic regimen but its potential thrombolytic superiority over SK remains to be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Prognostic significance of the extent of myocardial injury in acute myocardial infarction treated by streptokinase (the GISSI trial).

To evaluate the different contributions of infarct site and infarct extent in determining the in-hospital outcome and efficacy of thrombolytic therapy, 8,731 patients with a first Q-wave acute myocardial infarction (AMI) enrolled in the GISSI trial were studied. On the basis of the standard 12-lead electrocardiogram, the sample was classified in 2 ways: classic electrocardiographic site pattern (anterior, inferior, lateral and multiple location), and number of standard electrocardiographic leads with ischemic ST elevation (small, modest, large and extensive infarct in 2 to 9 leads). In-hospital mortality was evaluated according to infarct site, infarct extent and fibrinolytic treatment. The mortality rate was differently distributed in the various infarct sites. Streptokinase significantly reduced mortality only in anterior (13.8 vs 18.7%) and multiple site infarcts (8.1 vs 12.5%). According to the infarct extent observed, there is a progressive increase in the mortality rate--from 6.5% in small infarcts to 9.6% in modest, 14.3% in large and 21.7% in extensive. No significant benefit was obtained by streptokinase in small infarcts; in contrast, a significant decrease in mortality was achieved in modest (7.7 vs 11.4%), large (12.8 vs 16.6%) and extensive infarcts (19.5 vs 23.9%). Thus, the extent of myocardial injury seems to be more relevant than the site in determining in-hospital mortality and efficacy of thrombolytic therapy.

Electrocardiography↗
PubMed1993

Effects of streptokinase during acute myocardial infarction on the signal-averaged electrocardiogram and on the frequency of late arrhythmias.

Although a number of studies have shown that the incidence of late potentials is lower after thrombolytic therapy, it is not known whether this is paralleled by fewer arrhythmic events during long-term follow-up. In patients with first acute myocardial infarction, filtered QRS duration was significantly shorter when treated with streptokinase (95 +/- 11 ms, n = 53) than when treated with conventional therapy (99 +/- 12 ms, n = 77, p < 0.05). The low-amplitude signal (D40) was shorter after thrombolysis (28 +/- 11 vs 33 +/- 12 ms, p < 0.02). Terminal root-mean-square voltage did not differ significantly (41 +/- 24 vs 35 +/- 23 microV). Irrespective of treatment, late potentials were predictive in the complete group (n = 171) for arrhythmic events during follow-up (13 +/- 6 months, range 6 to 24) (hazard ratio 7.7, p < 0.02, Cox proportional-hazards survival analysis), but treatment (streptokinase vs conventional) did not significantly affect outcome when added to the model. It is concluded that thrombolysis prevents the development of late potentials. However, this study does not confirm the hypothesis that prevention of late potentials leads to a decrease in arrhythmic events.

Adult↗
PubMed1986

Inadvertent administration of streptokinase to patients with pericarditis.

Two patients with acute pericarditis who received intravenous streptokinase for presumed acute myocardial infarction are described. Although the administration of streptokinase did not cause an immediate increase in pericardial effusion, delayed nonhemorrhagic pericardial tamponade developed in both. Since pericarditis and other disease entities may mimic the pain and early electrocardiographic manifestations of acute myocardial infarction, precautions should be taken if thrombolytic therapy is given when there are no angiographic data to confirm the myocardial infarction. Pericarditis should be included in the differential diagnosis of patients with chest pain and ST segment elevation for the sake of diagnostic accuracy to avoid inappropriate therapy that may have some inherent risk.

Adult↗
PubMed1986

Localized intraarterial streptokinase therapy.

In a retrospective study, 26 patients underwent 34 episodes of selective intraarterial streptokinase infusion for peripheral arterial thromboembolic occlusive disease. Thrombolytic therapy was beneficial in 23 instances (67 percent), caused no change in 7 instances, and caused deterioration in 4 instances. Nine patients (26 percent) had a major complication and 15 (44 percent) had a minor complication. Puncture site hematoma, which occurred in 11 cases (32 percent), was the most frequent complication. Local thrombolytic therapy is an effective primary or adjuvant method of treatment for thromboembolic occlusive disease in properly selected patients. Protocols for the safe use of streptokinase therapy are necessary. Enthusiasm for thrombolytic therapy must be tempered by the recognition of its potential for serious complications, the requirement for intensive care monitoring, and the availability of dedicated radiologists and vascular surgeons.

Adult↗
PubMed1993

Rapid enzyme immunoassay of anti-streptokinase antibodies in human plasma.

A simple enzyme immunoassay for determination of anti-streptokinase antibodies (aSKa) in plasma is described. Commercially available reagents have been used for the assay, which is calibrated with a reference preparation of aSKa containing 100 AU/ml. The assay is specific and reproducible with a variation coefficient of 4.8%. In healthy individuals a broad range of values between 4 and 291 AU/ml was observed with a large difference between the mean and median value (55 AU/ml and 27 AU/ml, respectively). Data from a study on 21 patients with myocardial infarction treated with the streptokinase derivative antistreplase suggest that a high titre of aSKa before treatment is associated with failure of thrombolytic therapy. The assay procedure can be shortened to 0.5 h to screen patients for a high aSKa level. This assay allows a more routine assessment of aSKa in the clinic.

Anistreplase↗
PubMed1983

Effect on haemostasis of intravenous injection of alpha 2-antiplasmin in cats treated with streptokinase.

The effect in cats of an intravenous injection of purified human alpha 2-antiplasmin on changes in the haemostatic system, caused by administration of streptokinase was investigated. The decrease in fibrinogen and plasminogen caused by streptokinase infusion was immediately inhibited by the alpha 2-antiplasmin infusion. The increase in vascular permeability and the prolongation of coagulation times were efficiently inhibited.

Animals↗