Streptokinase is a
thrombolytic agent i.e. it dissolves vascular thrombi. This potent agent is
derived from the beta hemolytic streptococci and is consequently associated with
the risk of anaphylaxis. The risk is dependent upon the level of the patients
circulating anti-streptokinase antibodies. Streptokinase acts by stimulating the
conversion of plasminogen to plasmin. Is a proteolytic enzyme which is able to
disrupt fibrin stability and production? The half life of streptokinase in 6
Streptokinase may only be prepared.
Administered and monitored by nursing staff
who work in the Accident & Emergency
Department and ICU/CCU.
► Early in
myocardial infarction. Evidence of acute
anterior myocardial infarction within 6
hours of onset of episode of pain that
► Use of streptokinase for inferior infarcts
to be discussed with cardiologist/physician.
► Acute pulmonary and systemic arterial
► Suspected myocardial infarction marked by
an ECG with left bundle branch block.
► Absence of contraindications to
streptokinase and Aspirin.
PT Selection Criteria:
Onset of cardiac like chest pain which is >30 minutes
in duration and within six hours of
Chest pain for up to twenty four hours which
► Age over 70 years.
► Bacterial endocarditis
► Bleeding tendency
► Recent surgery or trauma, head injury or CPR.
► Previous IV Streptokinase re last 6 months.
► Ulcer or gastrointestinal hemorrhage or ulcerative reflux, esophagitis or ulcer symptoms
► Proliferative diabetic, retinopathy.
► Recent or planned arterial puncture previous or next 24 hours.
► Oral anticoagulants.
► Any history of CVA, Cerebral AV malformation and cerebral aneurysm
► Bleeding diathesis
► Surgery including dental extractions in past 14 days.
► Major trauma or head trauma in past 14 days.
► Uncontrolled hypertension diastolic >110 or greater
► Severe renal, liver disease, acute pancreatitis.
► Left heart thrombus.
► Prolonged (more than 15 minutes) and possibly traumatic CPR.
► Uncontrolled hypertension diastolic BP .120mmHg and systolic BP >300mmHg.
► Invasive procedure e.g. subclavian puncture in the last 10 days, inclusive of temporary pacemaker insertion.
► Bacterial endocarditis.
► GIT bleeds within 6 months.
Signs of repreinfusion:
► Relief of pain.
► Return of ST segments to normal.
► Reperfusion arrhythmias usually a dioventricular rhythm.
► Early CPK peak.
► Any of the contraindications.
► Avoid invasive procedures as far as possible.
► Beware of drugs causing effects on the clotting system or platelets and possible interaction with therapy.
► ECG machine
► Continuous ECG monitoring
► IV canola access
► Streptokinase 1.5 million u/s given in
100mls normal saline over 45-60 minutes.
► Blood pressure monitoring
► ECG and diagnosis.
► Bloods for FBC, U/E/C's, Coags, and Cardiac Enzymes group and hold.
► Soluble aspirin 150mgs orally then daily for at least 1 month.
► Give 1.5 million u/s streptokinase in 100mls normal saline or 5% dextrose over
45mins to 1 hour.
► Continuous monitoring of HR and rhythm throughout thrombolytic administration.
NB: Successful lysis of the clot may be
evidenced by reperfusion arrhythmias. These
may be of various forms; may be mild or
catastrophic. In effects emergency equipment
(cardiac arrest trolley and a defibrillator)
close at hand throughout infusion and post
24 hours. Reperfusion rhythms are only
treated when they are sustained and or
► Vital observations:
Record 15 minutely for at least 1 hour from
onset of infusion until stable. _ hourly for
a further hour then hourly for 24 hours.
Can occur in up to 20% of patient treated.
► Placing patient in supine position
► Reduce rate of infusion
► Stop infusion and restart when BP recovers
The risk of external and internal hemorrhage
is maximal in the first 24 hours.
Observation for and prevention include:
► Minimal duration of cuff inflation when
► Daily urinalysis for haematuria whilst
anti-coagulation therapy continues.
► Assessment reporting and documentation of
abdominal pain and/or distension, faecal
blood, neurological deficits and
► A least 5 minutes of compression for
Venipunctures sites during thrombolytic
► At least 2 minutes of compression for
Venipunctures sites during possible heparin
Allergic reactions may include fever
increased liver enzymes, reduced renal
function, polyarthralgia, polyarthritis and
rash. Should any of these reactions occur
the nurse is to notify the RMO immediately.
► Record ECG 2
hours post infusion twice daily for 48 hours
► Monitor CPK at 6 and 12 hours, then daily.
► Monitor APTT at 16-20 hours then daily till
an acceptable level.
► Test urine for blood.
► Assess need for heparin therapy as per
cardiology or physicians decision.
ET et al , Cardiovascular Drug Guidelines, 1995/96 2nd
Edition; RNSH/Coronary Care Policies/Procedures, 1993, Lismore Base Hospital
Streptokinase policy ICU & Emergency Dept.