Clinical application:
Streptokinase has the effect of promoting the activity of the fibrinolytic system in the body. It can convert the precursor of fibrinogen activator into an activator, which in turn converts fibrinogen into an active fibrinolytic enzyme, causing thrombus dissolution. After intravenous injection, T1/2 takes about 15 minutes.
Used for stroke,acute myocardial infarction, deep venous thrombosis, pulmonary embolism, cerebral embolism, acute subacute peripheral arterial thrombosis, central retinal arteriovenous thrombosis, coagulation formed during hemodialysis shunt, hemolytic and traumatic shock, and septic shock accompanied by disseminated intravascular coagulation (DIC).
Streptokinase Usage and Dosage:
- Half an hour before administration, first inject 25mg of promethazine intramuscularly and administer 2.5mg-5mg of dexamethasone or 25-50mg of hydrocortisone intravenously to prevent side effects (such as bleeding tendencies, flu-like shivers, fever, etc.).
- Initial dose: Dissolve 500,000 units of the product in 100ml of 0.9% sodium chloride injection solution or 5% glucose solution, and administer it intravenously by drip (to be completed in about 30 minutes).
- Maintenance dose: Dissolve 600,000 units of the product in 250-500ml of 15% glucose solution, add 25-50mg of hydrocortisone or 1.25-2.5mg of dexamethasone, and administer it intravenously by drip for 6 hours, maintaining a level of 100,000 units per hour. Follow this regimen four times a day, with the treatment lasting 24-72 hours or until the thrombus dissolves or the condition no longer progresses. The duration of the treatment depends on the condition, with retinal vascular occlusion generally requiring 12-24 hours of medication, acute myocardial infarction requiring 18-20 hours, peripheral arterial and venous thrombosis about 3 days, up to a maximum of 5-6 days, and longer for chronic arterial obstruction, but it should not exceed 6-7 days.
- At the end of the treatment, low molecular weight dextran can be used as a transition to prevent the reformation of thrombus.
- The initial dose for children should be determined based on the anti-streptokinase level, and the maintenance dose should be calculated based on blood volume, maintaining a level of 20 units per ml of blood volume per hour.
Adverse Reactions and Precautions of Streptokinase:
1.Since the human body is often infected with streptococci, there are usually antibodies to streptokinase (i.e., thrombolytic enzymes) present in the body. When using streptokinase, it is necessary to first administer a sufficient initial dose to neutralize these antibodies. Patients who have recently had a streptococcal infection may have a higher content of streptokinase antibodies in their bodies. Before using this product, the anti-streptokinase value should be determined. If it is greater than 1 million units, this product should not be used for treatment. Streptococcal infections and subacute endocarditis patients are contraindicated.
2.Bleeding is the main complication, usually manifesting as hematoma at the injection site. The treatment can continue without stopping the medication. For severe bleeding, aminocaproic acid or aminomethylbenzoic acid can be used to counteract the thrombolytic effect, and for more severe cases, fibrinogen or whole blood can be supplemented. During the use of this product, muscle injection and arterial puncture should be avoided as much as possible, as they may cause hematomas.
3.Patients who have recently undergone surgery are relatively contraindicated. Principally, this product should not be used within 3 days after surgery. However, if acute embolism occurs and emergency treatment is necessary, the use of high doses of this product (which can reduce the risk of bleeding) may be considered, but close attention should be paid to the issue of bleeding at the surgical site.
4.Within 6 weeks of pregnancy, 2 weeks before delivery, and 3 days after delivery, the risk of bleeding must be fully assessed before using this product. Patients with chronic gastric ulcers, newly diagnosed cavitary pulmonary tuberculosis, severe liver disease with a tendency to bleed should use this product with caution. It is contraindicated in bleeding disorders.
5.Patients who have used anticoagulants such as heparin can be neutralized with protamine before using this product. If the anticoagulant is a coumarin derivative, the coagulation status should be determined and normalized before this product can be used.
6.After using this product, a few patients may experience symptoms such as fever, chills, headache, and discomfort. Symptomatic treatment with antipyretic and analgesic drugs can be given.
7.When injected too quickly, it may cause allergic reactions, so medications such as promethazine and dexamethasone should be given to prevent their occurrence.
8.When dissolving, do not shake vigorously to avoid reducing the activity. The solution can be kept for 12 hours at around 5°C, but it should be used immediately at room temperature, as the activity may decrease if left for too long.
9.As an enzyme preparation, many chemicals such as protein precipitants, alkaloids, and disinfectants can reduce its activity, so it is not suitable for combined use.
The difference between urokinase and streptokinase:
Different pharmacological effects:
Urokinase can degrade fibrinogen coagulation factors in the bloodstream, thereby exerting a thrombolytic effect. It is mainly suitable for myocardial infarction, acute cerebral embolism, and retinal artery embolism; Streptokinase is the earliest thrombolytic drug used in clinical practice, which can bind with plasminogen and activate it into plasmin. It has the effect of dissolving blood clots and has therapeutic effects on deep vein thrombosis, peripheral artery thrombosis, and newly developed thrombosis after surgery.
Different adverse reactions:
Adverse reactions to urokinase are relatively rare, with a small number of patients showing bronchospasm, rash, etc; Common adverse reactions of streptokinase include fever, chills, nausea and vomiting, shoulder and back pain, allergic rash, bleeding at the puncture site, skin stasis, gastrointestinal, urinary or respiratory bleeding, etc.
Both urokinase and streptokinase may cause bleeding tendencies during use, so caution should be taken before use, and coagulation function should also be checked.If you are interested in becoming a pharmacist, you can visit this website.