Eptase

Indications

Streptokinase is a clot-dissolving (thrombolytic) medicine used in hospital to break down dangerous blood clots. Its main uses are early treatment of a heart attack (acute myocardial infarction with ST elevation) when a stent procedure is not quickly available, and treatment of serious clots such as large pulmonary embolism (clot in the lungs), deep vein thrombosis, clots in arteries of the arms or legs, and blocked dialysis or venous lines.

How It Works

Streptokinase is a protein made by streptococcus bacteria. In the blood it joins with plasminogen, a natural substance, and the pair converts more plasminogen into plasmin. Plasmin breaks down fibrin, the mesh that holds a clot together, so the clot dissolves and blood flow can return. For a heart attack, it works best when given as early as possible, ideally within a few hours of symptoms starting.

Dosage and Administration

Streptokinase is given only in hospital by doctors and nurses as an infusion into a vein (or occasionally into an artery or line). The dose and infusion time depend on the condition being treated and are given as prescribed. Patients are monitored closely for bleeding, blood pressure and heart rhythm, and other medicines such as Aspirin and Heparin are often given as part of treatment.

Interactions

• Anticoagulants (Heparin, Warfarin and newer blood thinners) and antiplatelet medicines (Aspirin, Clopidogrel, Ticagrelor, glycoprotein IIb/IIIa inhibitors) increase bleeding risk; their use is planned carefully by the doctor.
• NSAIDs such as Ibuprofen also increase bleeding risk.
• Previous Streptokinase treatment produces antibodies that can make it ineffective or cause allergy if given again.

Contraindications

• Active internal bleeding or a known bleeding disorder.
• Any history of bleeding stroke, or a recent clot stroke (usually within the last few months).
• Recent major surgery, serious head injury or brain surgery, or brain tumour or blood vessel malformation.
• Very high uncontrolled blood pressure.
• Suspected aortic dissection.
• Previous Streptokinase treatment (usually from 5 days to a year or more earlier) or previous allergy to it.

Side Effects

Common: bleeding from injection sites, gums or nose, bruising, low blood pressure during the infusion, fever, chills, nausea and allergic reactions such as rash and flushing. Irregular heart rhythms may occur as blood flow returns to the heart.

Get urgent medical help (tell staff at once) for sudden severe headache, weakness, confusion or trouble speaking, vomiting blood, black stools, blood in urine, difficulty breathing, swelling of the face or throat, or chest pain that returns.

Pregnancy and Lactation

Streptokinase may cause bleeding from the placenta and is used in pregnancy only when the doctor judges it necessary to save life, especially avoided in the first 18 weeks and around delivery. Breastfeeding is usually paused for a short time after treatment; follow the doctor's advice.

Precautions and Warnings

• Given only in a hospital setting with monitoring.
• Injections into muscle and unnecessary needle sticks are avoided during and after treatment.
• Extra care in older people, those with recent minor bleeding, liver disease, diabetic eye disease or recent streptococcal infection.

Overdose

Overdose increases the risk of serious bleeding. The infusion is stopped and bleeding is treated in hospital, for example with fresh frozen plasma, blood products or Tranexamic Acid.

Therapeutic Class

Thrombolytic (fibrinolytic) agent, plasminogen activator.

Storage

Hospital medicine: store as directed on the pack, usually below 25°C (some products 2 to 8°C), away from light and out of the reach of children.