Pharmacy World and Science

, Volume 17, Issue 5, pp 168–171 | Cite as

Adverse reaction to streptokinase with multiple systemic manifestations

  • Isabel Montserrat
  • Joan Altimiras
  • Mario Dominguez
  • Ruben Lamich
  • Ariadna Ollé
  • Jordi Fontcuberta
Practice/Case Reports


We report the case of a 47-year-old woman with a history of mitral valve replacement with a mechanical prosthesis who was admitted to the hospital with a 3-month history of progressive exertional dyspnoea and was diagnosed as suffering from prosthetic valve thrombosis. Two consecutive courses of streptokinase were given as an intravenous infusion over 90 min at a dose of 1,500,000 IU each. Twenty minutes after the start of the second infusion (3 h and 20 min after the first one) she developed chills, fever, tachycardia and hypotension; symptomatic treatment was given and the infusion was completed. Two days later jaundice and choluria appeared with laboratory findings of hepatic cytolysis and cholestasis and renal insufficiency. The results of extensive microbiological and immunological investigations were not revealing. All the laboratory values spontaneously returned to baseline levels over the next 4 weeks. These abnormalities were attributed to an allergic reaction to streptokinase, although the exact pathogenic mechanisms involved are not known. We believe that further studies to elucidate the mechanisms involved in the production of these effects are warranted in view of their potential clinical severity.


Adverse effects Liver diseases Prosthesis Streptokinase Thrombosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bednarczyk EM, Sherlock SC, Farah MG, Green JA. Anaphylactic reaction to streptokinase with first exposure: case report and review of the literature. DICP 1989;23:869–72.PubMedGoogle Scholar
  2. 2.
    McGrath KG, Patterson R. Anaphylactic reactivity to streptokinase. JAMA 1984;252:1314–7.PubMedGoogle Scholar
  3. 3.
    Maclennan AC, Ahmad N, Lawrence JR. Activities of aminotransferases after treatment with streptokinase for acute myocardial infarction. BMJ 1990;301:321–2.PubMedGoogle Scholar
  4. 4.
    Marder VJ, Sherry S. Thrombolytic therapy: current status (second of two parts). N Engl J Med 1988;318:1585–95.PubMedGoogle Scholar
  5. 5.
    Besse P, Ledain L, Ohayan J, Colle JP, Roudaut MF, Roudaut R. Thromboses aigües de prothèses valvulaires a disque: traitment fibrinolytique. Haemostasis 1986;16(Suppl 4):94–105.PubMedGoogle Scholar
  6. 6.
    Ortuño J, Fontcuberta J, Pons G, Montserrat I, Cladellas M, Llobet JM, Grau E. Successful treatment of prosthetic heart-valve thrombosis with high short-term doses of streptokinase. Lancet 1988;2:626.Google Scholar
  7. 7.
    Gruppo Italiano per lo Studio della Streptochinasi nell Infarto miocardio (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1:397–402.Google Scholar
  8. 8.
    Caron J, Libersa C. Drugs affecting blood clotting, fibrinolysis and hemostasis. In: Dukes MNG, editor. Meyler's side-effects of drugs. 12th ed. Amsterdam: Elsevier, 1992:733–75.Google Scholar
  9. 9.
    Sheffer AI. Anaphylaxis. J Allergy Clin Immunol 1985;75:227–33.PubMedGoogle Scholar
  10. 10.
    McGrath KG, Zeffren B, Alexander J, Kaplan K, Patterson R. Allergic reactions to streptokinase consistent with anaphylactic or antigen-antibody complex-mediated damage. J Allergy Clin Inmunol 1985;76:453–57.Google Scholar
  11. 11.
    Noel J, Rosenbaun LH, Gagadharan V, Stewart J, Galens G. Serum sickness-like illness and leukocytoclastic vasculitis following intracoronary arterial streptokinase. Am Heart J 1987;113:395–7.PubMedGoogle Scholar
  12. 12.
    Argent N, Adams PC. Proteinuria and thrombolytic agents. Lancet 1990;335:106.PubMedGoogle Scholar
  13. 13.
    Payne ST, Hosker HSR, Allen MB, Bradbury H, Page RL. Transient impairment of renal function after streptokinase therapy. Lancet 1989;2:1398.Google Scholar
  14. 14.
    Sallen MK, Efrusy ME, Kniaz JL, Wolfson PM. Streptokinase-induced hepatic dysfunction. Am J Gastroenterol 1983;78: 523–4.PubMedGoogle Scholar
  15. 15.
    Freimark D, Leor R, Hod H, Elian D, Kaplinsky E, Rabinowitz B. Impaired hepatic function tests after thrombolysis for acute myocardial infarction. Am J Cardiol 1985;67:227–33.Google Scholar
  16. 16.
    Polkey MI. Hepatic dysfunction induced by streptokinase. Am J Gastroenterol 1992;87:1062.Google Scholar
  17. 17.
    Karch F, Lasagna L. Toward the operational identification of adverse drug reaction. Clin Pharmacol Ther 1977;21:247–54.PubMedGoogle Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1995

Authors and Affiliations

  • Isabel Montserrat
    • 1
  • Joan Altimiras
    • 2
  • Mario Dominguez
    • 3
  • Ruben Lamich
    • 4
  • Ariadna Ollé
    • 2
  • Jordi Fontcuberta
    • 5
  1. 1.Department of HaematologyHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Department of PharmacyHospital de la Santa Creu i Sant PauBarcelonaSpain
  3. 3.Coronary UnitHospital de la Santa Creu i Sant PauBarcelonaSpain
  4. 4.Department of CardiologyHospital de la Santa Creu i Sant PauBarcelonaSpain
  5. 5.Thrombosis and Haemostasis UnitHospital de la Santa Creu i Sant PauBarcelonaSpain

Personalised recommendations