Indications

The activation of the coagulation cascade is multifactorial. Clot formation can occur
due to venous stasis, hypercoagulable states such as malignancy, or endothelial
injury. These conditions activate the coagulation cascade, which ultimately leads to
the development of a fibrin clot.
Streptokinase (Streptase), class of drugs called Thrombolytic Agents , that may be used
for the emergency treatment of an ischemic stroke (a stroke caused by a blood clot),
a heart attack (myocardial infarction), or a massive pulmonary embolism (PE). They
may also be used for other indications.

can be given intravenous or intracoronary within three hours of symptom onset for a
stroke, or within 12-24 hours of symptom onset for a heart attack.

Mechanism of Action
Plasminogen is an inactive molecule that becomes activated to plasmin when the
Arg/Val bond (peptide bonds) is cleaved. Plasmin breaks down fibrin clots created
by the blood clotting cascade.

Streptokinase that work by converting plasminogen to the natural fibrinolytic agent.

Plasmin lysis clots by breaking down the fibrinogen and fibrin contained in a clot.

Adverse Effects
More common
 Blurred vision
 confusion
 dizziness, faintness, or lightheadedness when getting up from a lying or sitting
position suddenly
 low blood pressure
 fever
 sweating
 unusual tiredness or weakness
 bleeding from wounds or gums.
Less common
 Blood in stool
 blood in urine
 nose bleeds
 red or purple spots on skin
 vomiting blood

Contraindications
The thrombolytic nature of streptokinase makes it contraindicated in patients with active
internal bleeding, as it can worsen bleeding in some patients. It is also contraindicated in
patients with severe uncontrolled hypertension, intracranial neoplasms, surgery
within two months, recent stroke, and intraspinal surgery.

Streptokinase administered with extreme caution to those who have experienced recent
trauma, coagulopathies or hematologic diseases, gastrointestinal bleeding,  organ biopsies,
or previous puncture of a non-compressible vessel. 

Streptokinase is a pregnancy Category C medication. The effects of streptokinase on a fetus

are unknown.

Monitoring
Due to streptokinase’s thrombolytic mechanisms of action, patients need monitoring
for bleeding. The patient's thrombin time, prothrombin time, partial thromboplastin
time, complete blood count, and any signs of bleeding demand careful surveillance.
Patients also need monitoring for signs and symptoms of reinfarction or vessel
occlusion.
Patients should also receive monitoring for signs and symptoms of an allergic
reaction, including fever, shivering, rash, or in rare cases, anaphylaxis.
Patients who have recently had exposure to beta-hemolytic streptococci may be
resistant to streptokinase therapy because it is a derivative of streptococci
polypeptides.