| Streptokinase
Streptokinase (Kabikinase)
Streptokinase
(strep-toe-KYE-nayz)
Pregnancy Category: C Kabikinase
Streptase (Rx)
Classification: Thrombolytic
agent
Action/Kinetics: Most clients
have a natural resistance to streptokinase that must be overcome with the loading dose
before the drug becomes effective. Streptokinase acts with plasminogen to produce an
``activator complex,'' which enhances the conversion of plasminogen to plasmin. Plasmin
then breaks down fibrinogen, fibrin clots, and other plasma proteins, promoting the
dissolution (lysis) of the insoluble fibrin trapped in intravascular emboli and thrombi.
Also, inhibitors of streptokinase, such as alpha-2-macroglobulin, are rapidly inactivated
by streptokinase. Onset: rapid; duration: 12 hr. t1/2, activator
complex: 23 min.
Uses: DVT; arterial thrombosis
and embolism; acute evolving transmural MI; pulmonary embolism. Also, clearing of occluded
arteriovenous and IV cannulae.
Contraindications: Any condition
presenting a risk of hemorrhage, such as recent surgery or biopsies, delivery within 10
days, ulcerative disease. Arterial emboli originating from the left side of the heart.
Also, hepatic or renal insufficiency, tuberculosis, recent cerebral embolism, thrombosis,
hemorrhage, SBE, rheumatic valvular disease, thrombocytopenia. Streptokinase resistance in
excess of 1 million IU.
Special Concerns: The use of
streptokinase in septic thrombophlebitis may be hazardous. History of significant allergic
response. Safety in children has not been established. Geriatric clients have an increased
risk of bleeding during therapy.
Side Effects: CV:
Superficial bleeding, severe internal bleeding. Allergic:
Nausea, headache, breathing difficulties, bronchospasm, angioneurotic edema
urticaria, flushing, musculoskeletal pain, vasculitis, interstitial nephritis, periorbital
swelling. Other: Fever, possible development of Guillain-Barre syndrome,
development of antistreptokinase antibody (i.e., streptokinase may be ineffective if
administered between 5 days and 6 months following prior use of streptokinase or following
streptococcal infections).
Laboratory Test Alterations:  Fibrinogen, plasminogen.  Thrombin time, PT, and activated PTT.
Drug Interactions: The following
drugs increase the chance of bleeding when given concomitantly with streptokinase:
anticoagulants, aspirin, heparin, indomethacin, and phenylbutazone.
How Supplied: Powder for
injection: 250,000 IU, 750,000 IU, 1.5 million IU
Dosage
•IV Infusion DVT, pulmonary embolism, arterial thrombosis or embolism.
Loading dose: 250,000 IU over 30 min (use the 1,500,000 IU vial diluted to 90 mL); maintenance:
100,000 IU/hr for 24-72 hr for arterial thrombosis or embolism, 72 hr for deep vein
thrombosis, and 24 hr (72 hr if deep vein thrombosis is suspected) for pulmonary embolism.
Acute evolving transmural MI.
1,500,000 IU within 60 min (use the 1,500,000 IU vial diluted to a total of 45 mL).
Arteriovenous cannula occlusion.
250,000 IU in 2-mL IV solution into each occluded limb of cannula and clamp off; then, after
2 hr aspirate cannula limbs, flush with saline, and reconnect cannula.
•Intracoronary Infusion Acute evolving transmural MI.
20,000 IU by bolus; then, 2,000 IU/min for 60 min (total dose of 140,000 IU). Use
the 250,000 IU vial diluted to 125 mL. |
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