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PubMed1997

Comparison of peak serum C-reactive protein and hydroxybutyrate dehydrogenase levels in patients with acute myocardial infarction treated with alteplase and streptokinase.

Peak serum C-reactive protein concentrations were measured in 146 patients randomized to receive streptokinase, alteplase, or a combination of streptokinase and alteplase in the GUSTO-I trial. Those receiving alteplase treatment had lower values than those receiving streptokinase or the combination treatment. Irrespective of treatment, complete reperfusion of the infarct-related artery (TIMI grade 3 flow) was associated with low peak serum C-reactive protein values.

Aged↗

PubMed1986

Treatment of grafts and major vessel thrombosis with low-dose streptokinase in children.

Low-dose streptokinase infusions have been used in 8 of our patients. Five of these were newborns who had major vessel occlusion. Four babies had extensive aortic thrombosis and hypertension producing congestive aortic thrombosis and hypertension producing congestive heart failure. One baby had caval and renal vein thrombosis and was in renal failure. Two infants with cyanotic heart disease and 1 with arteritis had occluded prosthetic grafts, which were reopened completely. Two grafts were between the subclavian and pulmonary arteries (Blalock-Taussig shunt), and one was between the abdominal aorta and right renal artery. In each patient, the thrombolytic agent was delivered directly to the area of thrombosis by three or four percutaneously inserted French catheters. The dose of streptokinase used was between 50 and 100 U/kg/hr. Therapy lasted for 2 to 11 days. Major bleeding was anticipated, and it occurred in 1 patient. Low-dose streptokinase infusion is a safe and effective treatment for a variety of thrombotic problems in infants and children.

Child↗

PubMed1987

The use of intracatheter instillation of streptokinase in the treatment of recurrent bacterial peritonitis in continuous ambulatory peritoneal dialysis.

Recurrent bacterial peritonitis resistant to therapy with antibiotics is seen in a small percentage of patients maintained on continuous ambulatory peritoneal dialysis. In these patients, removal of the Tenckhoff catheter is necessary to achieve a cure. Sequestration of bacteria within fibrin clots located on the catheter has been postulated to contribute to this resistance to standard therapy. We, therefore, examined the efficacy of intraperitoneal streptokinase in combination with antibiotic therapy in the treatment of two patients with recurrent bacterial peritonitis. After addition of streptokinase to the therapeutic regimen, no further episodes of peritonitis were observed after 6 to 8 weeks follow-up. These data suggest that intraperitoneal streptokinase may be useful as adjunctive therapy in the treatment of recurrent bacterial peritonitis.

Catheterization↗

PubMed2001

[Treatment with intrapleural streptokinase for coagulated hemothorax after cardiac surgery with cardiopulmonary bypass].

INTRODUCTION AND OBJECTIVES: Coagulated hemothorax is a complication of cardiac surgery with cardiopulmonary bypass. The objective of this study was to present the authors' experience in the intrapleural infusion of streptokinase for the treatment of this complication. METHODS: From January 1996 to June 1999, nine patients (6 males, 3 females, age range: 1-75 years) were clinically and radiographically diagnosed with coagulated hemothorax after cardiac surgery. All patients were treated with intrapleural infusion of streptokinase at a standard dose of 250,000 units in adult patients and 12,000 U/kg in pediatric cases. In cases of occluded chest drainage, the position of the patient was changed and drainage was opened. RESULTS: In all the cases clinical and radiological improvement was observed and 100 to 200 ml of hemothorax was obtained on drainage. One patient died of multiorgan failure due to the underlying disease not related to the procedure. No alteration were observed in hematological tests including coagulation. The other 8 patients were discharged from hospital and remain without pulmonary compromise to date. CONCLUSION: Treatment of coagulated hemothorax with intrapleural infusion of streptokinase is a useful procedure and avoid the need for surgical drainage of hemothorax.

Adult↗

PubMed1984

Clinical failure of streptokinase due to an unsuspected high titer of antistreptokinase antibody.

Neutralization of streptokinase by an unsuspected high titer of antistreptokinase antibody prevented activation of the fibrinolytic system and induction of a lytic state in a 62 year old man with an acute inferior myocardial infarction. There was no decrease in serum fibrinogen, minimal decrease in serum plasminogen and only a small increase in serum fibrin degradation products after intravenous administration of 1.5 million units of streptokinase. A high titer of antistreptokinase antibody, sufficient to neutralize 1.5 million units of streptokinase, was demonstrated by semiquantitative counterelectrophoresis . There was no clinical evidence of coronary artery reperfusion, and coronary angiography confirmed complete occlusion of the left circumflex artery.

Antibodies, Bacterial↗

PubMed1987

Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty.

Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect.

Adult↗

PubMed1987

Status of the myocardium and infarct-related coronary artery in 19 necropsy patients with acute recanalization using pharmacologic (streptokinase, r-tissue plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty) or combined types of reperfusion therapy.

In acute myocardial infarction, myocardial salvage is dependent on rapid restoration of blood flow. Pharmacologic (streptokinase, recombinant tissue-type plasminogen activator), mechanical (percutaneous transluminal coronary angioplasty, guide wire perforation) or combined forms of reperfusion therapy can accomplish this goal, but their effects on infarcted myocardium and vessel occlusion site have not been compared at necropsy. The heart of 19 necropsy patients who had received various forms of acute reperfusion therapy was studied: 14 had pharmacologic or combined forms of reperfusion therapy (13 streptokinase and 1 tissue-type plasminogen activator, including 4 with combined balloon angioplasty) and 5 had had purely mechanical (balloon angioplasty) reperfusion therapy. Reperfusion was initially clinically successful in all 19 patients with the average time from onset of symptoms to reperfusion being 3.7 hours. Necropsy observations separated the 19 patients into distinct subgroups based on changes in the myocardium and infarct-related coronary arteries. Of the 19 patients, 14 (74%) had hemorrhagic myocardial infarction and they all received pharmacologic or combined forms of reperfusion therapy. The remaining five patients (26%) had nonhemorrhagic (anemic) infarction and were treated with balloon angioplasty therapy alone. Increased luminal cross-sectional area was present in 8 of 9 patients with acute balloon angioplasty but severe coronary atherosclerotic plaque remained in 9 of 10 patients without acute balloon angioplasty. Severe hemorrhage surrounded angioplasty sites in all four patients who also received streptokinase or tissue-type plasminogen activator. Severe bleeding at the angioplasty site compromised the dilated coronary lumen in one patient. No patient with angioplasty alone had intraplaque bleeding. Thus, acute coronary balloon angioplasty reperfusion therapy alone appears to avoid the potentially adverse effects of myocardial and intraplaque hemorrhage while simultaneously increasing luminal cross-sectional area at the site of acute occlusion.

Adult↗

PubMed1995

Comparison of streptokinase, urokinase, and recombinant tissue plasminogen activator in an in vitro model of venous thrombolysis.

PURPOSE: Presumed differences in the thrombolytic activity and fibrinolytic specificity of the three commonly used thrombolytic agents, streptokinase, urokinase, and recombinant tissue plasminogen activator (rt-PA), are based on clinical study results, where variability renders meaningful comparisons difficult. An in vitro model of catheter-directed venous thrombolysis was used to compare the three agents. METHODS: Retracted iodine 125-radiolabeled clots that simulate those observed in the venous system were infused with thrombolytic agents at doses analogous to those used clinically. Perfusion with heparinized, whole human blood was undertaken for 60 minutes, measuring the efficacy of thrombolysis through serial quantification of radio tracer released into the circuit. Fibrinolytic specificity was determined by following decrements in perfusate fibrinogen concentration. RESULTS: Streptokinase was the agent associated with the slowest rate of clot lysis (p = 0.01 vs urokinase and rt-PA). Urokinase was associated with an intermediate rate of lysis but appeared to be the agent with the greatest degree of fibrinolytic specificity (p = 0.02 vs streptokinase, p = 0.05 vs rt-PA). Although rt-PA was associated with improved efficacy early in the perfusions, the differences between rt-PA and urokinase dissipated after 30 minutes. CONCLUSIONS: These laboratory observations suggest that urokinase may be the most appropriate agent for catheter-directed venous thrombolysis, offering an advantageous compromise between fibrinolytic specificity and thrombolytic speed.

Analysis of Variance↗

PubMed1995

Analysis of the interaction of group A streptococci with fibrinogen, streptokinase and plasminogen.

Group A streptococci demonstrate a number of distinct ways to interact with the human fibrinolytic system to acquire unregulatable cell-surface enzymatic activity. Interactions between bacteria, fibrinogen, streptokinase and plasminogen resulted in acquisition of cell-associated enzymatic activity that can lyse fibrin clots despite the presence of the major physiological plasmin inhibitor, alpha 2-antiplasmin. Western blot analysis of extracted streptococcal surface proteins suggested that binding of fibrinogen to M or M-related proteins mediated the capture of streptokinase-plasminogen complexes to the bacteria. The enzymatic complex formed by reaction of bacteria with fibrinogen, streptokinase and plasminogen was found to be more stable in human plasma than pre-formed plasmin bound directly to the same bacteria strain.

Aminocaproic Acid↗

PubMed2003

Intraventricular streptokinase for the treatment of posthaemorrhagic hydrocephalus of preterm.

Posthaemorrhagic hydrocephalus following intraventricular haemorrhage is still one of the most serious complications of premature birth. Small premature babies are not suitable for shunt surgery because of high cerebrospinal fluid protein and risk of obstruction. For this reason there is a great need for alternative approaches for treatment of posthaemorrhagic hydrocephalus. The objective of this study was to investigate if intraventricular streptokinase treatment reduces the need for ventriculoperitoneal shunt in posthaemorrhagic hydrocephalus. A case-control trial was carried out in 12 premature babies with posthaemorrhagic hydrocephalus. Six of them were treated with intraventricular streptokinase and 6 premature babies were in the control group. While 5 babies in the study group needed ventriculoperitoneal shunt, 3 of the control patients needed shunt surgery. There were no rebleeding, ventriculitis or meningitis in either groups. In conclusion on the basis of our results we do not recommend routine use of intraventricular streptokinase in posthaemorrhagic hydrocephalus.

Apgar Score↗

PubMed1975

Kinetic mechanism of the activation of human plasminogen by streptokinase.

A method of determining the initial rate of plasminogen activation has been developed. The method has been used to investigate the mechanism of activation of human plasminogen by streptokinase. Plasmin formation follows saturation kinetics. Inhibition of plasmin formation by epsilon-aminocaproic acid is uncompetitive with a Ki of 0.6 mM. A model consistent with the data is that streptokinase induces a conformational change in the plasminogen molecule, producing an active center which cleaves an internal peptide bond to produce plasmin. Thus, streptokinase functions as a catalytic allosteric effector.

Enzyme Activation↗

PubMed1999

Comparison of the predictive value of ST segment elevation resolution at 90 and 180 min after start of streptokinase in acute myocardial infarction. A substudy of the hirudin for improvement of thrombolysis (HIT)-4 study.

AIMS: Previous studies revealed that >/=70% or <30% ST segment elevation resolution 180 min after the start of thrombolysis is a strong predictor of either favourable or poor outcome. The aim of this study was to compare the prognostic value of ST segment elevation resolution at 90 and 180 min after the start of streptokinase infusion. METHODS AND RESULTS: The Hirudin for Improvement of Thrombolysis (HIT)-4 study of 1208 patients compared streptokinase therapy in conjunction with either r-hirudin or heparin. Complete ST segment elevation resolution (>/=70%) at 90 and 180 min identified 25% and 50%, respectively, of all patients with a 30 day cardiac mortality of less than 2%. Forty-four percent of patients had no ST segment elevation resolution (<30%) at 90 min and the 30 day cardiac mortality was 7.3%. At 180 min, the no ST segment elevation resolution group decreased to 15% of all patients while the mortality risk increased to 13.6%. CONCLUSIONS: ST segment elevation resolution is a useful tool for early risk stratification and the strategy of rescue angioplasty. Complete ST segment elevation resolution within 180 min of the start of streptokinase therapy indicates excellent survival prospects in 50% of patients. A half of these low risk patients can be identified at 90 min. A high risk group appears to be best characterized by no ST segment elevation resolution at 180 min rather than at 90 min.

Double-Blind Method↗

PubMed2002

Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study.

AIMS: To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS: A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION: Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.

Adult↗

PubMed1983

[Reactive leukemoid plasmacytosis with polyclonal hypergammaglobulinemia during streptokinase therapy].

Plasma cells are occasionally encountered in peripheral blood during fibrinolytic treatment with streptokinase. Leukaemoid plasmocytosis and increase of immunoglobulins were observed in a 44-year-old patient in connection with streptokinase treatment. Mature stages of plasma cells could be demonstrated in peripheral blood. The observed phenomena are considered as exaggerated immune response to foreign protein. They are of no disease value as they are only concomitant reactions to streptokinase treatment. Spontaneous regression occurred.

Adult↗

PubMed1983

[Local streptokinase thrombolysis in a Cimino shunt thrombosis].

Local thrombolysis treatment was successful in a 52-year-old woman with a one-day old thrombosis of her Cimino shunt. Three hours after local application of a total of 80 000 IU streptokinase the shunt, which had thrombosed at the distal venous loop, became patent again. Because of the low streptokinase dose local thrombolysis, in contrast to systemic streptokinase administration, can be used without danger even in patients on haemodialysis in whom systemic thrombolytic treatment is frequently contra-indicated.

Administration, Topical↗

PubMed1981

[Intravenous streptokinase infusions in acute myocardial infarction. Restoring patency of occluded thrombotic coronary vessels (author's transl)].

Intravenous treatment over 30 minutes with 500 000 U streptokinase was given to 21 patients with acute myocardial infarction. Serial measurements of serum CK-MB activity made recanalisation of the infarcted artery likely in 3 patients. Selective coronarography was performed in 18 patients during the acute infarction phase. Angiographic follow-up investigations were done 24 hours and after 3 weeks. In 3 cases only subtotal occlusion of the infarcted coronary artery was seen during the acute phase. A thrombus demonstrated in two patients could be lysed. In 8 out of 15 patients with complete coronary artery occlusion the infarcted vessel was reopened 20-60 minutes after onset of intravenous streptokinase infusion. In a further 4 patients recanalisation was observed 60-140 minutes after passing a guide wire or during an additional intracoronary infusion of streptokinase. The infarcted vessel remained occluded in 3 patients, one of whom died following myocardial rupture. In 12 patients with recanalisation of the infarcted artery during the acute phase a premature maximum of serial CK-MB serum activity was seen after 13.5 +/- 2.9 hours in comparison with 20.9 +/- 5.3 hours in 122 patients treated conventionally. Serial enzyme determinations allow indirect conclusions as to a rapid recanalisation of an infarcted blood vessel.

Angiocardiography↗

PubMed1980

[Local streptokinase treatment in acute pulmonary embolism with shock (author's transl)].

Streptokinase (290 000 U/2 h) was directly infused under angiographic control into the predominantly affected right pulmonary artery in a 71-year-old patient with acute pulmonary embolism and persistent shock. This led to immediate complete remission of shock symptoms and lasting stabilisation of the patient. If, as this case demonstrates, embolectomy is not possible and high-dose intravenous streptokinase is contraindicated, localised use of streptokinase in low dosage offers a possibility for treatment of life-threatening pulmonary embolism.

Aged↗

PubMed1992

Cost effectiveness of thrombolytic therapy with streptokinase in elderly patients with suspected acute myocardial infarction.

BACKGROUND: There is a lack of consensus among cardiologists about the potential benefit of thrombolytic therapy for suspected acute myocardial infarction in older patients. To investigate this issue, we constructed a decision-analytic model for patients 75 years of age or older who present with ST-segment elevation within six hours of the onset of symptoms suggesting acute myocardial infarction. METHODS: The variables incorporated in this model were the probability that the patient has an acute myocardial infarction, the probability of in-hospital death among patients with acute myocardial infarction who do not receive thrombolytic therapy, the probability of a fatal or incapacitating complication resulting from thrombolytic therapy, and the expected relative reduction in the risk of death associated with thrombolytic therapy in patients with acute myocardial infarction. Our analyses were based primarily on the use of streptokinase as the thrombolytic agent. RESULTS: Given our base-line assumptions, the probability of dying in the hospital was 21.4 percent if thrombolytic therapy was given and 24.4 percent if it was not given. In one-way sensitivity analyses, thrombolytic therapy decreased the risk of dying if the probability that the patient had an acute myocardial infarction was assumed to be greater than 9 percent, if the probability of dying in the hospital after an acute myocardial infarction without thrombolytic therapy was assumed to be greater than 3 percent, if the rate of fatal or incapacitating complications due to thrombolytic therapy was assumed to be 4 percent or less, or if the relative reduction in the risk of death associated with thrombolytic therapy was assumed to be greater than 1 percent. On the basis of our base-line assumptions, our estimate of the cost effectiveness of streptokinase therapy (the cost per year of life saved) for an 80-year-old patient with suspected acute myocardial infarction was $21,200. For a wide range of assumptions about risks, benefits, and costs, the cost per year of life saved remained less than $55,000. CONCLUSIONS: Within the limitations imposed by the assumptions used in our analysis, thrombolytic therapy with streptokinase was found to be a beneficial and cost-effective treatment for suspected acute myocardial infarction in elderly patients in a wide variety of clinical circumstances.

Age Factors↗