Streptokinase

• Fibrinolytic agent (derivative of the beta-hemolytic streptococci)

• Catalyzes plasminogen to convert into plasmin (which degrades fibrin in clots)
• Works on old as well as recent blood clots

• ST segment elevation myocardial infarction (STEMI)
• Acute massive pulmonary embolism (PE)
• Deep vein thrombosis (DVT)
• Acute arterial thrombi
• Occluded arteriovenous cannula

• Onset: immediate
• Peak: rapid
• Half-Life: 83 minutes
• Duration:  4 – 12 hours

• Bleeding (intracranial, past clots from surgeries, arterial or venipuncture sites)
• Hypotension
• Fever (foreign antigen)
• Hypersensitivity (urticaria, hives, flushing, headache, bronchospasms, anaphylaxis) [Streptokinase has protein antigens from the Streptococcal culture from which it is isolated.]
• Reperfusion dysrhythmias (PVC's, ventricular tachycardia, ventricular fibrillation)

• Active internal bleeding (GI, peptic ulcer, urinary tract) in past 2 months
• Previous history of intracranial hemorrhage
• Known structural cerebral vascular lesion (e.g., AV malformation)
• Known malignant intracranial neoplasm (primary or metastatic)
• Ischemic stroke within 3 months
• Suspected aortic dissection
• Active bleeding or bleeding tendency (except menses)
• Significant closed head trauma or facial trauma within 3 months
• Systolic BP ≥ 180 mm Hg
• Diastolic BP ≥ 110 mm Hg
• Recent trauma, surgery (including laser eye surgery), or GI/GU bleeding within past 2 months
• CPR > 10 minutes in past 2 months
• Pregnant female

• Intravenous:  STEMI:  1.5 million international units IV infusion over 1 hour (60 minutes)

                                    DVT:   250,000 international units IV infusion over 30 minutes

• Drug Interactions:  1) Anticoagulants like heparin or enoxaparin increase the risk of bleeding; 2) Aminocaproic acid reverses the action of streptokinase
• Drug Incompatibilities:  Do not use infusion IV line for other medications or therapies.
• Screen patient carefully for possible contraindications prior to fibrinolytic therapy.
• Obtain baseline lab data for aPTT, PT, INR, Hct, Hgb, and platelets prior to beginning streptokinase therapy.
• Avoid any invasive procedures on patient during therapy and for 2 hours following therapy.
• Monitor the patient for signs of bleeding every 15 minutes during therapy and hourly for next 8 hours following therapy.
• Notify physician STAT if signs of anaphylaxis or allergic reaction begin to occur.
• Maintain continuous cardiac monitoring during therapy and at least for the next eight hours to watch for reperfusion dysrhythmias.
• Reperfusion dysrhythmias rarely require treatment, but appropriate resuscitation medications and equipment should be at the bedside.
• Evidence of reperfusion include 1) relief of chest pain, 2) reperfusion dysrhythmias, 3) return of ST segments to baseline in affected leads, and 4) peaking of serum CK-MB
• Watch for neurological alterations (like change in mental status, level of consciousness, seizures, hemiparesis/hemiplegia, changes in pupils, etc.) which may indicate cerebral hemorrhage.
• Do not give any injections, draw blood specimens (especially not arterial), or perform any other form of venipuncture during fibrinolytic therapy.
• Do not use noninvasive blood pressure monitoring on patient during fibrinolytic therapy.