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Severe bleeding such as intracranial haemorrhage may occur following administration of the drug, particularly in the elderly patients. The risk must be balanced against the potential benefit of thrombolysis.
The following precautions need to be observed: Patients should be carefully observed for clinical signs during and following administration of the drug for early detection of bleeding. Frequent haematological tests such as blood coagulation tests are mandatory.
To prevent bleeding at the site of centesis or other regions, caution must be exercised concerning procedures and management of arterial/ venous puncture.
The use of heparin in conjunction with the thrombolytic agent for the purpose of prevention of reocclusion may increase the risk of intracranial haemorrhage. Close monitoring of patients is strongly recommended.
The following conditions would normally be considered contraindications to streptokinase therapy, but in certain situations the benefits could outweigh the potential risks: recent severe gastrointestinal bleeding, e.g. active peptic ulcer; risk of severe local haemorrhage, e.g. in case of translumbar aortography; recent trauma and cardiopulmonary resuscitation; invasive operations, e.g. recent intubation; puncture of non-compressible vessels, intramuscular injections, large arteries; recent abortion or delivery; pregnancy; diseases of the urogenital tract with existing or potential sources of bleeding (implanted bladder catheter); known septic thrombotic disease; severe arteriosclerotic vessel degeneration, cerebrovascular diseases; cavernous pulmonary diseases, e.g. open tuberculosis or severe bronchitis; mitral valve defects or atrial fibrillation; aortic dissection; diabetic retinopathy increase risk of local bleeding.
Antistreptokinase: Repeat treatment with streptokinase administered more than 5 days and less than 12 months after initial treatment may not be effective. This is because of the increased likelihood of resistance due to antistreptokinase antibodies.
Also, the therapeutic effect may be reduced in patients with recent streptococcal infections such as streptococcal pharyngitis, acute rheumatic fever and acute glomerulonephritis.
Infusion rate and corticosteroid prophylaxis: At the beginning of therapy, a fall in blood pressure, tachycardia or bradycardia (in individual cases going as far a shock) are commonly observed. Therefore, at the beginning of therapy the infusion should be performed slowly.
Corticosteroids can be administered prophylactically to reduce the likelihood of infusion-related allergic reactions.
Pre-treatment with heparin or coumarin derivatives: If the patient is under active heparinization, it should be neutralised by administering protamine sulphate before the start of the thrombolytic therapy. The thrombin time should not be more than twice the normal control value before thrombolytic therapy is started. In patients previously treated with coumarin derivatives, the INR (International Normalized Ratio) must be less than 1.3 before starting the streptokinase infusion.
Simultaneous treatment with acetylsalicylic acid: Recent evidence indicates that controlled-dose adjuvant acetylsalicyclic therapy in combination with streptokinase is capable of improving the response in the management of acute myocardial infarction. See also Dosage & Administration.
Streptokinase is not indicated for restoration of patency of intravenous catheters.
Effects on Ability to Drive and Use Machines: Not Applicable.
