Streptokinase Dosing for Cardiovascular Emergencies

Dosing and Administration

The European Society of Cardiology recommends administering streptokinase as 1.5 million units intravenously over 30-60 minutes for acute myocardial infarction 1, 2
Streptokinase should be considered when primary PCI cannot be performed by an experienced team within 120 minutes of first medical contact, as recommended by the European Society of Cardiology 2
Administration of streptokinase may be associated with hypotension, but severe allergic reactions are rare, according to the European Heart Journal 3
Re-administration of streptokinase should be avoided due to antibodies that can impair its activity and increase risk of allergic reactions, as stated by the European Heart Journal 3

The European Society of Cardiology recommends administering aspirin with streptokinase (150-500 mg orally or 250 mg IV if oral ingestion is not possible) 1, 4
Clopidogrel should be added to aspirin (loading dose of 300 mg orally if aged ≤75 years, followed by maintenance dose of 75 mg/day), as recommended by the European Society of Cardiology 1, 4
The benefits of aspirin and streptokinase are additive, according to the European Heart Journal 3
Anticoagulation is recommended until revascularization (if performed) or for the duration of hospital stay up to 8 days, as stated by the European Society of Cardiology 3, 2

Unfractionated heparin: 60 U/kg IV bolus (maximum 4000 U) followed by IV infusion of 12 U/kg/hr (maximum 1000 U/hr) for 24-48 hours, targeting aPTT 50-70 seconds or 1.5-2.0 times control, as recommended by the European Society of Cardiology 1, 4
Enoxaparin: For patients <75 years, 30 mg IV bolus followed by 1 mg/kg SC every 12 hours; for patients >75 years, no IV bolus with first SC dose of 0.75 mg/kg, as stated by the European Society of Cardiology 1, 4
Fondaparinux: 2.5 mg IV bolus followed by 2.5 mg SC once daily (preferred with streptokinase), as recommended by the European Society of Cardiology 1, 4, 2

Monitor for reperfusion: relief of symptoms, maintenance of hemodynamic/electrical stability, and reduction of ST-segment elevation by at least 50% at 60-90 minutes, as recommended by the American College of Cardiology 5
Transfer to a PCI-capable center following fibrinolysis is indicated in all patients, according to the European Society of Cardiology 2
Angiography with a view to revascularization is recommended after successful fibrinolysis, optimally between 3-24 hours, as stated by the European Society of Cardiology 2
Monitor for bleeding complications, which occur in 4-13% of patients, according to the European Heart Journal 3
Watch for hypotension, which commonly occurs with streptokinase administration, as stated by the European Heart Journal 3

Streptokinase should not be re-administered due to antibody formation, as recommended by the European Heart Journal 3
Intracranial hemorrhage occurs in 0.9-1.0% of patients, according to the European Heart Journal 3
Risk factors for intracranial hemorrhage include lower weight, female sex, previous cerebrovascular disease, and systolic/diastolic hypertension on admission, as stated by the European Heart Journal 3
Fibrin-specific agents (tenecteplase, alteplase, reteplase) are generally preferred over streptokinase due to better safety profile, according to the European Society of Cardiology 2