Summary
Streptokinase is an antigenic thrombolytic agent used for the treatment of acute myocardial infarction. It reduces mortality as effectively as the nonantigenic alteplase in most infarct patients while having the advantage of being much less expensive. This cost implication is important since myocardial reinfarction is common, with fibrinolytic therapy indicated in many patients with reinfarction. Following streptokinase, antistreptokinase antibodies and neutralisation titres can rise to significant levels from 4 days after the initial dose. These antibodies can presist for at least 4 years in up to 50% of patients. It is possible that these antibodies may cause allergic reactions or neutralisation of a further dose of streptokinase, rendering it ineffective for the treatment of myocardial reinfarction. To date, 2 small studies of patients without previous streptokinase exposure suggest that higher antibody titres are associated with a lower rate of coronary reperfusion, while a further study suggests that high titres are associated with hypersensitivity reactions. At present the readministration of streptokinase cannot be recommended from 4 days after a first dose. Further larger studies are needed to assess the effect of high neutralisation titres on coronary reperfusion.
Similar content being viewed by others
References
Alpert JS. Coronary vasomotion, coronary thrombosis, myocardial infarction, and the camel’s back. J Am Col Cardiol 1985; 5: 617
Epstein SE, Palmeri ST. Mechanism contributing to precipitation of unstable angina and acute myocardial infarction: implications regarding therapy. Am J Cardiol 1984; 54: 1245–52
Willerson JT, Campbell WB, Winniford MD, et al. Conversion from chronic to acute coronary artery disease: speculation regarding mechanisms. Am J Cardiol 1984; 54: 1349–54
White HD, Norris RM, Brown MA, et al. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med 1987; 317: 850–5
GISSI (Gruppo Italiano per lo Studio della Streptochinasi nell’ Infarto Miocardico). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 397–402
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349–60
Lee HS, Cross SJ, Davidson R, et al. Hypersensitivity reactions to streptokinase in patients with high pre-treatment antistreptokinase antibody and neutralisation titres. Eur Heart J 1993; 14: 1640–3
Verstraete M, Vermylen J, Amery A, et al. Thrombolytic therapy with streptokinase using a standard dosage scheme. BMJ 1966; 1: 454–6
Lee HS, Cross SJ, Davidson R, et al. Raised levels of antistreptokinase antibody and neutralisation titres from four days to 54 months after administration of streptokinase or anistreplase. Eur Heart J 1993; 14: 84–9
Jalihal S, Morris K. Antistreptokinase titres after intravenous streptokinase. Lancet 1990; 335: 184–5
Lynch M, Littler WA, Pentecost BL, et al. Immunoglobulin response to intravenous streptokinase in acute myocardial infarction. Br Heart J 1991; 66: 139–42
White HD, Cross DB, William BF, et al. Safety and efficacy of readministration of thrombolytic treatment after acute myocardial infarction. Br Heart J 1990; 64: 177–81
Fears R, Ferres H, Glasgow E, et al. Monitoring of streptokinase resistance titres in acute myocardial infarction patients up to 30 months after giving streptokinase or anistreplase and related studies to measure specific antistreptokinase IgG. Br Heart J 1992; 68: 167–70
GREAT Group. Feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. BMJ 1992; 305: 548–53
British National Formulary. Number 29. London: British Medical Association and the Pharmaceutical Press, Royal Pharmaceutical Society of Great Britian, March 1995
GISSI-2. A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet 1990; 336: 65–71
ISIS-3. A randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. Lancet 1992; 339: 753–70
GUSTO Investigators. An international randomized trial comparing thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673–82
Rivers JT, White HD, Cross DB, et al. Re-infarction after thrombolytic therapy for acute myocardial infarction followed by conservative management: incidence and effect of smoking. J Am Coll Cardiol 1990; 16: 340–8
Elliott JM, Cross DB, Cederholm-Williams S, et al. Neutralizing antibodies to streptokinase four years after intravenous thrombolytic therapy. Am J Cardiol 1993; 71: 640–5
Buchalter MB, Suntharalingam G, Jennings I, et al. Streptokinase resistance: when might streptokinase administration be ineffective? Br Heart J 1992; 68: 449–53
Patel S, Jalihal S, Dutka DP, et al. Streptokinase neutralisation titres up to 866 days after intravenous streptokinase for acute myocardial infarction. Br Heart J 1993; 70: 119–21
Massel D, Turpie AG, Cairns JA, et al. Persistence of neutralisation antibodies at one year following IV streptokinase for acute myocardial infarction. Circulation 1990: 82Suppl. III: 254
Massel D, Turpie AG, Cairns JA, et al. Previous streptokinase therapy inhibits subsequent streptokinase thrombolysis. Circulation 1991; 84Suppl. II: 467
Brugemann J, Van de Meer J, Born VJJ, et al. Anti-streptokinase antibodies inhibit fibrinolytic effects of anistreplase in acute myocardial infarction. Am J Cardiol 1993; 72: 462–4
Gemmill JD, Hogg KJ, Dunn FG, et al. Pre-dosing antibody levels and efficacy of thrombolytic drugs containing streptokinase. Br Heart J 1994; 72: 222–5
Shaila G, Chandrashekhar YS, Kumar N, et al. Antistreptokinase antibodies before and after streptokinase therapy in patients with acute myocardial infarction from area endemic for streptococcal infection and influence on reperfusion rates. Am J Cardiol 1994; 74: 187–9
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lee, H.S. How Safe is the Readministration of Streptokinase?. Drug-Safety 13, 76–80 (1995). https://doi.org/10.2165/00002018-199513020-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199513020-00002