S-Kinase

Approved Indications:

• Acute myocardial infarction (AMI), specifically:
• ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset
• Pulmonary embolism (PE), including massive and submassive PE with hemodynamic instability
• Deep vein thrombosis (DVT) in selected cases requiring thrombolysis
• Arterial thrombosis and embolism (e.g., peripheral arterial occlusion)
• Occluded intravenous catheters (off-label in some regions)

Off-label (Clinically Accepted) Uses:

• Acute ischemic stroke (less commonly used now due to newer agents)
• Prosthetic valve thrombosis
• Other thrombotic conditions where rapid clot dissolution is critical

Adults:

• Acute Myocardial Infarction (AMI):
• Intravenous (IV) infusion of 1.5 million international units (IU) over 60 minutes, sometimes preceded by a loading dose of 250,000 IU over 30 minutes depending on protocol.
• Pulmonary Embolism:
• 250,000 IU IV over 30 minutes (loading dose) followed by 100,000 IU/hour continuous infusion for 24–72 hours depending on severity and response.
• Deep Vein Thrombosis (DVT) & Arterial Thrombosis:
• Dosing individualized; typically, 250,000 IU loading dose followed by continuous infusion.

Pediatrics:

• Limited data; dosing must be weight-based and individualized; use under specialist guidance.

Elderly:

• No routine dose adjustment, but increased bleeding risk; careful monitoring recommended.

Special Populations:

• Renal/Hepatic Impairment:
• No specific dose adjustment but caution advised due to bleeding risk.

Administration Route:

• Intravenous infusion (slow infusion preferred; rapid bolus generally avoided).

Streptokinase is a fibrinolytic agent that activates plasminogen to plasmin, an enzyme that degrades fibrin clots. It forms a complex with plasminogen, inducing a conformational change that exposes the active site, converting plasminogen into plasmin. Plasmin then enzymatically breaks down fibrin, fibrinogen, and other clotting factors, leading to clot dissolution and restoration of blood flow in occluded vessels.

• Absorption: Not applicable (administered IV)
• Distribution: Rapidly distributed in the plasma with a volume of distribution approximately equal to plasma volume.
• Metabolism: Cleared by the reticuloendothelial system and proteolytic degradation in plasma.
• Excretion: Metabolites eliminated primarily by the kidneys.
• Half-life: Biphasic, initial half-life approx. 18 minutes; terminal half-life approx. 83 minutes.
• Onset of action: Fibrinolytic activity begins within minutes after administration.

• Pregnancy: Category C – Animal studies have shown adverse effects on the fetus, no adequate human studies. Use only if potential benefit justifies the risk.
• Lactation: Unknown if excreted in human milk. Caution advised when administered to breastfeeding women.

• Thrombolytic agent (Fibrinolytic)
• Enzyme-based plasminogen activator

• Known hypersensitivity to streptokinase or any component of the formulation
• Previous streptokinase therapy within the past 6 months (risk of allergic reaction)
• Active internal bleeding or bleeding diathesis
• History of hemorrhagic stroke or stroke of unknown origin
• Recent (within 3 months) ischemic stroke or intracranial/spinal surgery or trauma
• Severe uncontrolled hypertension
• Aortic dissection
• Intracranial neoplasm, arteriovenous malformation, or aneurysm

• High risk of bleeding complications, including intracranial hemorrhage
• Monitor for signs of hypersensitivity/anaphylaxis during and after administration
• Use caution in patients with recent surgery, trauma, or invasive procedures
• Careful cardiovascular monitoring during administration to detect arrhythmias or reperfusion injury
• Avoid invasive procedures during and shortly after treatment
• Platelet count and coagulation parameters should be monitored

Common:

• Bleeding at any site (gums, nose, injection sites)
• Hypotension
• Fever
• Allergic reactions (rash, itching)

Serious:

• Intracranial hemorrhage (potentially fatal)
• Anaphylaxis or severe hypersensitivity reactions
• Reperfusion arrhythmias
• Hemorrhagic stroke

Timing:

• Adverse effects can occur during infusion or within hours post-infusion, especially bleeding events.

• Anticoagulants (e.g., heparin, warfarin): Increased bleeding risk
• Antiplatelet agents (e.g., aspirin, clopidogrel): Increased bleeding risk
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Increased bleeding risk
• Other thrombolytics: Additive fibrinolytic effect and bleeding risk
• No significant CYP450 enzyme involvement

• Current guidelines from AHA/ACC and ESC support streptokinase use in settings lacking immediate access to primary percutaneous coronary intervention (PCI) for STEMI patients.
• Emphasis on early administration (within 12 hours of symptom onset) to improve outcomes.
• Recent safety updates stress strict contraindications to minimize bleeding risks.
• Ongoing developments favor newer fibrin-specific thrombolytics, but streptokinase remains widely used globally due to cost-effectiveness.

• Store at 2°C to 8°C (Refrigerated)
• Protect from light and moisture
• Do not freeze
• Reconstitute with sterile water for injection as per manufacturer instructions immediately before use
• Use reconstituted solution promptly to maintain potency and sterility