Streptokinase – A Powerful Thrombolytic Agent for Heart Attacks and Embolic Conditions

 

Introduction:

*Streptokinase* is a *fibrinolytic (clot-dissolving) drug* used in emergency medical situations like *acute myocardial infarction (AMI)*, *deep vein thrombosis (DVT)*, and *pulmonary embolism (PE)*. Derived from beta-hemolytic streptococci, it helps dissolve blood clots and restore normal blood flow. It is one of the earliest and most cost-effective thrombolytics used worldwide.

Mechanism of Action:

Streptokinase forms a complex with *plasminogen*, converting it into *plasmin*, which then breaks down fibrin clots. Unlike Alteplase, it *activates both circulating and fibrin-bound plasminogen*, increasing the risk of systemic bleeding.

Pharmacokinetics:

- *Route*: Intravenous infusion  

- *Half-life*: 23–25 minutes  

- *Onset of action*: 10–20 minutes after administration  

- *Duration*: Up to 12 hours  

- *Metabolism*: Proteolytic enzymes degrade the complex  

- *Excretion*: Renal

Pharmacodynamics:

- Promotes *systemic fibrinolysis*

- Can cause *hypotension* due to rapid clot breakdown

- No enzymatic activity on its own; requires plasminogen to function

Indications:

- *Acute ST-Elevation Myocardial Infarction (STEMI)*

- *Pulmonary Embolism (PE)*

- *Deep Vein Thrombosis (DVT)*

- *Occluded arteriovenous cannulas or catheters*

- *Peripheral arterial embolism*

Contraindications:

*Absolute:*

- Active internal bleeding

- History of hemorrhagic stroke

- Recent major surgery or trauma

- Uncontrolled hypertension

- Known bleeding disorders

*Relative:*

- Pregnancy

- Recent GI bleeding

- Severe liver or kidney disease

- Bacterial endocarditis

Side Effects: 

- *Hemorrhage* (major or minor)

- *Hypotension*

- *Allergic reactions* (rash, fever, anaphylaxis)

- *Fever/chills*

- *Reperfusion arrhythmias*

- *Antibody formation* (limits repeat use)

Dosage:

*For Acute MI:*

- *1.5 million IU IV infusion over 60 minutes*

*For PE or DVT:*

- Varies based on protocol: usually 250,000 IU as a loading dose, followed by 100,000 IU/hour for several hours

Brand Names:

- *Streptase*  

- *Kabikinase*  

- *Streptokinase Lupin*  

- *Thrombozime*

Price (may vary by region): 

- *Cost per vial (1.5 million IU)*:  

  - *Pakistan*: PKR 2,000–6,000 

 

  - *International*: USD 20–100

Conclusion:

Streptokinase remains a *widely used and economical thrombolytic agent*, especially in developing countries. Though newer agents like Alteplase are more specific, *Streptokinase’s affordability and accessibility* make it essential in emergency cardiovascular care. Careful screening is needed due to its bleeding risk and immunogenicity.