streptokinase (Kabikinase®, Streptase®)
Fibrinolytic (thrombolytic)
A derivative of the beta-hemolytic streptococci, streptokinase combines with plasminogen to produce an activator complex that converts free plasminogen to the proteolytic enzyme plasmin. The plasmin in turn functions as an enzyme that degrades fibrin threads as well as fibrinogen, causing lysis of the blood clot. Streptokinase is administered to selected patients with acute evolving myocardial infarctions.
10-20 min (fibrinolysis, 10-20 min; clot lysis, 60-90 min)
3-4 hours (prolonged bleeding times up to 24 hours)
Acute evolving myocardial infarction
Massive pulmonary emboli
Arterial thrombosis and embolism
To clear arteriovenous cannulas
Hypersensitivity
Active bleeding
Recent surgery (within 2-3 weeks)
Recent CVA
Prolonged CPR
Intracranial or intraspinal surgery
Recent significant trauma (particularly head trauma)
Uncontrolled hypertension
Recent streptococcal infection
Bleeding (GI, GU, intracranial, other sites)
Allergic reactions
Hypotension
Chest pain
Reperfusion dysrhythmias
Abdominal pain
Acetylsalicylic acid may increase risk of bleeding (may also be beneficial in improving overall effectiveness)
Heparin and other anticoagulants may increase risk of bleeding as well as improve overall outcome
250,000, 600,000, 750,000, 1.5 million IU vials
Reconstitute by slowly adding 5 ml of sodium chloride or D5W, directing the stream toward the side of the vial, rather than into the powder. Gently roll – do not shake- the val for reconstitution. Slowly dilute the entire contents of the vial to total of 45 ml.
IV: 750,000 to 1.5 million U diluted to 45 ml over 1 hr.
Not recommended.
Pregnancy Safety: Category A
Do not administer IM injections to patients receiving fibrinolytic drugs.
Obtain blood sample for coagulation studies prior to administration.
Carefully monitor vital signs
Observe the patient for bleeding.
Use caution when moving patient to avoid bruising or bleeding.
Do not draw arterial blood gas specimens in fibrinolytic therapy candidates.