Adult Dosing
Acute evolving transmural myocardial infarction
- Intravenous infusion: 1,500,000 IU within 60 minutes after onset of symptoms
- Intracoronary infusion: 20,000 IU by bolus followed by 2,000 IU/min for 60 minutes
Pulmonary embolism
- Loading dose: 250,000 IU/30 minutes IV. If concurrent DVT is suspected in 72 hrs: Initiate 100,000 IU/hr IV for 24 hours
Deep vein thrombosis
- Loading dose of 250,000 IU/30 minutes IV followed by 100,000 IU/hr IV for 72 hours
Arterial thrombosis or embolism
- Loading dose of 250,000 IU/30 minutes IV followed by 100,000 IU/hr IV for 24-72 hour
Arteriovenous cannulae occlusion
- Instill 250,000 IU streptokinase in 2 mL of solution into each occluded limb of the cannula slowly. Clamp off cannula limb(s) for 2 hours. Observe the patient closely for possible adverse effects. After treatment, aspirate contents of infused cannula limb(s), flush with saline, reconnect cannula
Pediatric Dosing
- Safety and efficacy in pediatric population have not been established
- Should only be used in hospitals where the recommended diagnostic and monitoring techniques are available
- Addition of aspirin to streptokinase may cause a slight increase in the risk of minor bleeding. Venipunctures and physical handling of the patient should be performed carefully and as infrequently as possible to minimize the risk of bleeding during treatment with streptokinase also intramuscular injections must be avoided
- Reperfusion atrial or ventricular dysrhythmias have been reported during rapid lysis of coronary thrombi. Careful monitoring for arrhythmia is recommended during and immediately following administration of streptokinase. Rare events of tachycardia and bradycardia have also been observed
- Hypotension has been reported during intravenous administration of streptokinase
- Rare events of cholesterol embolism has been observed in patients treated with all types of thrombolytic agents including with streptokinase
- Non-cardiogenic pulmonary edema has been reported rarely in patients treated with streptokinase
Cautions: Use cautiously in
- Recent major surgery, obstetrical delivery, organ biopsy, previous puncture of noncompressible vessels
- Recent serious gastrointestinal bleeding
- Recent trauma, including cardiopulmonary resuscitation
- Hypertension
- High likelihood of left heart thrombus (mitral stenosis with atrial fibrillation)
- Subacute bacterial endocarditis
- Hemostatic defects, including those secondary to severe hepatic or renal disease
- Pregnancy
- Age >75 years
- Cerebrovascular disease
- Diabetic hemorrhagic retinopathy
- Septic thrombophlebitis or occluded AV cannula at seriously infected site
- Any condition which bleeding constitutes a significant hazard or would be difficult to manage because of its location
Pregnancy Category:C
Breastfeeding: Safety unknown
