MyMedR

Fulltext Pathophysiology of streptokinase-induced hypotension in acute myocardial infarction: a systematic review of clinical evidence

Khalid K, Ahmad RE, Tong AYH, Lui SY, Abidin IZZ

Arch Med Sci Atheroscler Dis, 2021;6:e85-e94.

PMID: 34027217 DOI: 10.5114/amsad.2021.105410

Introduction: Despite the common occurrence of streptokinase-induced hypotension among patients with acute myocardial infarction, the underlying pathophysiology remains obscure and poorly understood. Our study aimed to pool clinical evidence on the potential mechanism of streptokinase-induced hypotension through a systematic review of the literature.

Material and methods: We conducted literature search from Medline, Scopus and Web of Science on clinical studies related to streptokinase-induced hypotension.

Results: Our search yielded 972 citations. After removal of duplicates, 878 articles were screened for eligibility, of which 856 papers were excluded due to various reasons. Of the remaining 22 articles retrieved with full texts, eight relevant articles were selected for final analysis. Three themes emerged as the proposed mechanisms of streptokinase-induced hypotension, including (i) reduction in total peripheral resistance, (ii) complement activation, and (iii) dismissal of hypotheses involving other intermediaries.

Conclusions: Our findings suggest that the underlying mechanism of streptokinase-induced hypotension lies primarily in the reduction in total peripheral resistance.

Matched MeSH terms: Streptokinase

Fulltext Acute myocardial infarction survival rate and complications after streptokinase therapy in Hospital Universiti Sains Malaysia, Kelantan--a comparative study

Hishamuddin HM, Azmi NN, Jackson N

Singapore Med J, 1993 Aug;34(4):316-8.

PMID: 8266202

Thrombolytic therapy is a well-established therapy in acute myocardial infarction (AMI), reducing mortality and infarct size. This study is a retrospective analysis of survival and complications after the use of streptokinase at Hospital Universiti Sains Malaysia. Streptokinase was first used here in March 1990. Between then and February 1992, 126 patients were admitted to the Coronary Care Unit. Thirty-two patients who fulfilled our criteria for thrombolytic treatment were given an hour intravenous infusion of 1.5 MU streptokinase, and started on aspirin. A control group of 64 patients selected from before March 1990, and matched for age, sex and site of infarct, was given standard therapy. The survival at 4 weeks post-AMI was 91% in the streptokinase therapy group and 91% in both groups (p > 0.05). The complications encountered were reperfusion arrhythmias (2 patients), hypotension(1), maculopapular rash(1) and gum bleeding(1). None of these complications were statistically increased when compared to the control group and none resulted in the death of a patient. We conclude that streptokinase therapy can be given safely in a rural Malaysian setting. Our survival and complication rates are comparable with other published series.

Matched MeSH terms: Streptokinase/administration & dosage; Streptokinase/therapeutic use*

Fulltext Massive hemothorax following administration of intrapleural streptokinase

Chai FY, Kuan YC

Ann Thorac Med, 2011 Jul;6(3):149-51.

PMID: 21760848 DOI: 10.4103/1817-1737.82451

The administration of intrapleural streptokinase (IPSK) is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis.

Matched MeSH terms: Streptokinase

Irreversible blindness following intravenous streptokinase

Peyman M, Subrayan V

JAMA Ophthalmol, 2013 Oct;131(10):1368-9.

PMID: 23929315 DOI: 10.1001/jamaophthalmol.2013.4489

Matched MeSH terms: Streptokinase/adverse effects*

Ancrod enhances the thrombolytic effect of streptokinase and urokinase

Cercek B, Lew AS, Hod H, Yano J, Lewis B, Reddy KN, et al.

Thromb Res, 1987 Aug 15;47(4):417-26.

PMID: 3660351

Since thrombi continue to incorporate fibrin during lysis we tested the effect of pretreatment with ancrod, a defibrinating agent from Malaysian pit viper venom, on thrombolysis with urokinase and streptokinase. Thrombi were induced by copper-coils in the carotid arteries of the dogs, weighed after 1 hour and inserted into the femoral arteries of the same animals. They were then exposed for 15 min to iv boluses of streptokinase 10,000 U/kg, urokinase 10,000 U/kg and urokinase 25,000 U/kg with or without pretreatment with ancrod. Ancrod depleted fibrinogen within 5 min and enhanced the lytic effect of streptokinase from 25 +/- 8% to 59 +/- 13% (p less than .05), urokinase 10,000 U/kg from 16 +/- 11% to 66 +/- 18% (p less than .01) and urokinase 25,000 U/kg from 27 +/- 17% to 85 +/- 8% (p less than .001) of the initial thrombus weight. Ancrod itself did not activate plasminogen to plasmin. We conclude that ancrod enhances thrombolysis probably by depleting fibrinogen and preventing new fibrin incorporation into the thrombus during lysis.

Matched MeSH terms: Streptokinase/pharmacology*

Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses

Cheah FC, Boo NY, Rohana J, Yong SC

J Paediatr Child Health, 2001 Oct;37(5):479-82.

PMID: 11885713

OBJECTIVE: To determine whether intravenous infusion of low dose of streptokinase was effective in lysing umbilical arterial catheter (UAC)-associated aortic thrombi.

METHOD: A prospective cohort study of 31 consecutive newborn infants with UAC-associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty-two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra-indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals - 26.0, - 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.

CONCLUSION: Low dose streptokinase infusion was effective and safe in thrombolysing UAC-associated aortic thrombi.

Matched MeSH terms: Streptokinase/administration & dosage; Streptokinase/therapeutic use*

Streptokinase infusion for asparaginase-induced arterial thrombosis

Omar KZ, Ariffin H, Abdullah WA, Chan LL, Lin HP

Med. Pediatr. Oncol., 2000 May;34(5):377-8.

PMID: 10797367

Matched MeSH terms: Streptokinase/administration & dosage; Streptokinase/therapeutic use*

Fulltext Wire-Induced Stent Crumpling Remedied By Bail- Out Crush Stenting; A Case Report.

Azarisma, S.M.S., Rosli, M.A.B.

International Medical Journal Malaysia, 2011;10(2):29-31.

MyJurnal

We report a-56-year old army pensioner who presented initially to a peripheral hospital with acute ST-elevation inferior myocardial infarction thrombolysed with streptokinase. He was subsequently referred to the National Heart Institute (Institut Jantung Negara, Malaysia) for coronary revascularization. Coronary angiogram revealed an ectatic right coronary artery with discrete lesions at the proximal and distal segments stented with bare metal stents (BMS). Post dilatation shots revealed a wire-induced, distal dissection at the posterior left ventricular artery remedied by balloon angioplasty but resulting in balloon-induced crumpling of the distal BMS. We discuss the importance of sequential, distal-to-proximal coronary intervention, stent crumpling and remedial strategies.

Matched MeSH terms: Streptokinase

Fulltext Intrapleural streptokinase for the treatment of chylothorax

Kuan YC, How SH, Ng TH, Abdul Rani MF

Respir Care, 2011 Dec;56(12):1953-5.

PMID: 21682984 DOI: 10.4187/respcare.01207

Chylothorax is suspected when milky white turbid fluid is obtained from thoracocentesis. Conservative management usually involves intercostal tube drainage, dietary restriction, and total parenteral nutrition. Surgery is indicated when conservative management fails. We describe a young woman with idiopathic chylothorax who failed conservative therapy but refused surgery. We instilled intrapleural streptokinase, which improved her condition.

Matched MeSH terms: Streptokinase/administration & dosage*

Fulltext Thrombolytic failure with streptokinase in acute myocardial infarction using electrocardiogram criteria

Lee YY, Tee MH, Zurkurnai Y, Than W, Sapawi M, Suhairi I

Singapore Med J, 2008 Apr;49(4):304-10.

PMID: 18418522

This study was primarily aimed to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria and its association between various independent variables and outcome parameters.

Matched MeSH terms: Streptokinase/adverse effects*

Fulltext Streptokinase after Spinal Anaesthesia – A Case Report

Hadi, M.R.A., Basri, M.N., Ariff, O.

International Medical Journal Malaysia, 2006;5(1):1-4.

MyJurnal

The use of thrombolytic agent e.g. streptokinase is indicated in patients with early acute ST elevation myocardial infarction (MI) (if there are no contraindications) is becoming increasingly routine. Its use is however significantly limited by bleeding complications. Spinal epidural haematoma (SEH) is haemorrhage in the spinal epidural space after spinal anaesthesia. SEH may be acute or chronic, spontaneous, posttraumatic, or iatrogenic but its occurrence appears to be particularly associated with acquired coagulopathy from medications and disease states. Patients usually present with acute axial spine pain and evolving focal neurological deficits. With increasing number of available anticoagulants and patient receiving them, anaesthesiologists today have to face the challenge of balancing between risks and benefits of regional anesthesia in patients under such medications. The treatment of this condition involves the principles of conservative follow-up directed by an improving examination and an understanding of the pathophysiology of coagulopathy-induced spontaneous epidural bleeds. When the diagnosis is accomplished rapidly, surgical decompression can result in full functional recovery.

Matched MeSH terms: Streptokinase

Microvascular thrombosis in pediatric multiple organ failure: Is it a therapeutic target?

Nguyen T, Hall M, Han Y, Fiedor M, Hasset A, Lopez-Plaza I, et al.

Pediatr Crit Care Med, 2001 Jul;2(3):187-196.

PMID: 12793940

PURPOSE: To discuss the current rationale for the use of specific and nonspecific therapies for thrombotic microangiopathy in thrombocytopenia-associated pediatric multiple organ failure syndromes. Methods: Pertinent PubMed and MEDLINE citations and proceedings of recent critical care meeting presentations were reviewed. RESULTS: Critical care clinicians have reported using antithrombin III concentrate, protein C concentrate, activated protein C, prostacyclin and its analogues, heparin, tissue factor pathway inhibitor concentrate, plasma infusion, plasma exchange, whole blood exchange, pentoxifylline, tissue plasminogen activator, urokinase, and streptokinase with perceived therapeutic benefits in patients with thrombocytopenia-associated multiple organ failure, including those with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, disseminated intravascular coagulation syndrome, and secondary thrombotic microangiopathy syndrome without prolonged prothrombin time/activated partial thromboplastin time. CONCLUSION: Assuming that underlying disease is remediable, a consensus has developed that thrombotic microangiopathy is a therapeutic target in children with thrombocytopenia-associated multiple organ failure syndromes. Studies are warranted to delineate efficacious use of specific and nonspecific therapies to prevent and reverse thrombotic microangiopathy in these patients.

Matched MeSH terms: Streptokinase

Fulltext Massive, spontaneous ruptured renal subcapsular haematoma following thrombolytic therapy in acute ST-elevation myocardial infarction

Raja Ezman Faridz Raja Shariff, Sazzli Shahlan Kasim

Journal of Clinical and Health Sciences, 2019;4(2):82-85.

MyJurnal

Thrombolytic therapy remains widely used in majority of developing countries, where delivery
of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately,
complications following such therapy remains prominent, predominantly bleeding-related
problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma
following thrombolytic therapy. A 61-year old gentleman presented following an episode of
chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining
PCI, the patient was counselled for thrombolysis using streptokinase which he had consented
to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria,
hypotension and altered mental status, associated with acute drops in haemoglobin levels.
Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was
performed revealing a massive renal subcapsular hematoma, likely secondary to previous
thrombolysis. Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter
often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include
trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic
renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our
literature search revealed only one other similar case, although this was following
administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic
cerebrovascular accident. This case highlights the complexity in management, following the
findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent
selection.

Matched MeSH terms: Streptokinase

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