Streptokinase Dosing and Administration for Acute STEMI

Dose and Infusion Regimen

The European Society of Cardiology recommends a single intravenous dose of 1.5 million units of streptokinase, diluted in 100 mL of 5 % dextrose or 0.9 % saline, administered over 30–60 minutes (30‑minute accelerated or 60‑minute standard infusion)【@1】.

Streptokinase does not require mandatory intravenous heparin co‑therapy, unlike fibrin‑specific thrombolytics【@1】.
Subcutaneous heparin or no heparin are acceptable adjuncts when streptokinase is used【@1】.
Intravenous heparin should be added for high‑risk patients (large or anterior MI, atrial fibrillation, prior embolus, or known left‑ventricular thrombus)【@3】.
When IV heparin is used, the regimen is 60 U/kg bolus (max 4000 U) followed by 12 U/kg/h infusion (max 1000 U/h), titrated to maintain an activated partial thromboplastin time 1.5–2.0 × control (≈50–70 seconds)【@3】.

Aspirin 150–325 mg should be chewed immediately (non‑enteric‑coated), then continued at 75–160 mg daily【@1】.
If oral administration is impossible, give 250 mg aspirin intravenously【@1】.

Streptokinase must never be re‑administered because neutralizing antibodies persist for ≥10 years, reducing efficacy【@1】.
Prior streptokinase or anistreplase exposure is an absolute contraindication【@1】.
For repeat fibrinolysis, use alteplase, reteplase, or tenecteplase instead of streptokinase【@1】.
Absolute contraindications (European Society of Cardiology):

The American Heart Association indicates that the largest mortality benefit is achieved when streptokinase is administered within 2–6 hours of symptom onset【@5】.
Efficacy declines markedly after 3 hours from symptom onset【@6】.
The recommended door‑to‑needle time is ≤30 minutes from hospital arrival【@5】.