Streptokinase – House Officer Guide

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Last Updated on February 13, 2023

Table of Contents

Introduction

1.5 MU diluted in 100 mL normal saline, given over 1 hour

Notes: Make sure no bubble in the solution

Contraindications to thrombolysis
Absolute contraindications	Risk of intracranial haemorrhage	• History of intracranial bleed • History of ischaemic stroke within 3 months • Known structural cerebral vascular lesion (e.g. ateriovenous malformation) • Known intracranial neoplasm
	Risk of bleeding	• Active bleeding / bleeding diathesis (excluding menses) • Suspected aortic dissection • Significant head trauma within 3 months
Relative contraindications	Risk of intracranial haemorrhage	• History of ischaemic stroke >3 months • Severe uncontrolled HTN on presentation (BP >180 / 110 mmHg) • Chronic, severe uncontrolled hypertension
	Risk of bleeding	• Current use of anticoagulant in therapeutic doses (INR >2) or DOAC • Recent major surgery <3 weeks • Recent internal bleeding (GI / urinary tract haemorrhage) • Active peptic ulcer • Non-compressible vascular puncture • Traumatic / prolonged CPR >10 minutes
	Others	• Pregnancy • Prior exposure (>5 days and within 12 months of first usage) to streptokinase (if planning to use streptokinase )
High risk patients	• Large infarcts • Anterior infarcts • Hypotension / cardiogenic shock • Significant arrhythmias • Elderly • Post-revascularization (post-CABG / post-PCI) • Post-infarct angina

• Streptokinase should not be given again between 3 days – 12 months after initial treatment with streptokinase

• Streptokinase is antigenic; it’s is a bacterial product which promotes production of antibodies. It will be less effective in the above mentioned period body has the ability to build up an immunity to it.
Further info: Wikipedia / Myokinase

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