Rheological Therapy
Gordon D. O. Lowe in Clinical Blood Rheology, 2019
Streptokinase combines with and activates circulating plasminogen, causing digestion of intravascular fibrin: hence it is used for thrombolytic therapy. Degradation of plasma fibrinogen (to fibrinogen degradation products, FDP) also occurs during streptokinase therapy: the fall in plasma fibrinogen level results in reduction in plasma viscosity, blood viscosity, and red cell aggregation.64-66 These rheological effects may conceivably increase blood flow and contribute to the clinical efficacy of streptokinase therapy in venous thrombosis and arterial disease (Chapter 13, this volume). Clinical application of thrombolytic therapy is increasing rapidly, especially in acute myocardial infarction, and agents which selectively degrade fibrin rather than fibrinogen are under development, e.g., tissue plasminogen activator (t-PA).67 While the thrombolytic efficacy and bleeding risk of such agents may be improved compared to streptokinase, their rheological effects will presumably be less marked, since fibrinogen levels do not fall to the same extent.67
Wound care
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Type II. Monomicrobial. Although more recently methicillin-resistant Staphylococcus aureus (MRSA) has been implicated, the causative agent is usually group A β-haemolytic streptococci (e.g. Streptococcus pyogenes) carried in the nose/throat of 15% of the population. This is the classic ‘flesh-eating bacteria’; it can also contribute to type I infections. Type II NF can affect all age groups and the healthy (up to a half); there is an association with varicella zoster and NSAIDs. The (lower) extremity is affected most often. There are a number of virulence factors: Exotoxin, e.g. streptococcal pyrogenic exotoxin A (SpeA); this superantigen (antigens that cause non-specific activation of T-cells resulting in polyclonal T-cell activation and massive cytokine release) causes systemic upset.Streptokinase that activates plasminogen and fibrinolysis.Hyaluronidase.Haemolysins.M proteins that inhibit opsonisation by an alternative complement pathway.
Acute coronary syndrome
Hugh McGavock, Dennis Johnston in Treating Common Diseases, 2017
Bleeding, symptomatic hypotension and allergic reactions are the most common and serious reactions associated with streptokinase therapy. However, hypertension can be associated with reperfusion, due to successful thrombolysis and recanalisation. Allergic reactions - which include fever, rashes, serum sickness, polyneuropathy and (rarely) anaphylaxis (an allergic emergency) - occur in about 12% of patients treated. These reactions are rarely seen with other thrombolytic agents, e.g. alteplase, and severe reactions usually occur on re-exposure. Any condition which increases the risk of bleeding represents a relative or absolute contraindication to the use of streptokinase and other thrombolytic agents. A previous history of an allergic reaction to streptokinase is an absolute contraindication. Great care is also required when giving thrombolytic drugs to patients who are already receiving anticoagulants and antiplatelet drugs.
Formulation, optimisation and in-vitro, in-vivo evaluation of surfactant stabilised nanosuspension of Ginkgo biloba
Published in Journal of Microencapsulation, 2019
Saba Aslam, Nazish Jahan, Khalil-Ur-Rehman , Shaukat Ali
Thrombolytic potential of coarse and nanosuspension of G. biloba was determined by in-vitro clot-lysis method. Venous blood was drawn from healthy human volunteers (n = 9) in pre-weighed, sterile centrifuge tubes and incubated at 37 °C for 45 min. Serum was removed after the formation of clot and tubes were weighed again to determine the clot weight. Coarse and nanosuspension (100 µl) of G. biloba were added to tubes containing the blood clot. As a positive and negative control, 100 µl of streptokinase and water were also added in separate tubes having blood clot. All the tubes were kept for 90 min at 37 °C and observed for clot lysis. Tubes were weighed again after the removal of fluid. Positive (streptokinase) and negative (water) control were also run similarly (Khan et al.2011).
Recent advances in targeted delivery of tissue plasminogen activator for enhanced thrombolysis in ischaemic stroke
Published in Journal of Drug Targeting, 2018
Masumeh Zamanlu, Mehdi Farhoudi, Morteza Eskandani, Javad Mahmoudi, Jaleh Barar, Mohammad Rafi, Yadollah Omidi
The first thrombolytic therapy was performed for the pleural fibrosis in 1949 [51,52]. The thrombolytic agent used was streptokinase, and this agent together with urokinase constitutes the first generation of thrombolytic agents introduced [53]. Streptokinase has been prescribed in myocardial infarctions, mostly because of its lower cost despite higher possibility for complications such as haemorrhage in comparison with that of tPA [54]. However, the most prominent weakness for the first generation thrombolytic agents and some of the second generation agents is that they induce ‘systemic fibrinolytic state’, in large part due to the activation of plasminogen which is not restricted to the clot fibrin. Such activation is against delicate fibrin specificity, which may lead to higher risk of complications [55]. This generation induces higher immunologic reactions and allergic complications as well [56].
Pharmacological thrombolysis: the last choice for salvaging free flaps
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Sik Namgoong, Jong-Phil Yang, Seong Ho Jeong, Seung Kyu Han, Woo Kyung Kim, Eun Sang Dhong
Streptokinase, originating from β-hemolytic streptococci, can form a plasminogen complex and activate other plasminogen substances. Moreover, it works by depleting endogenous plasmin inhibitors, decreasing blood viscosity, and preventing erythrocyte aggregation [22]. Unfortunately, allergic reactions to streptokinase are quite common owing to its bacterial origin and have been reported in 0.1% of patients [21,23,24]. Symptoms include fever, bronchospasm, hypotension, and urticaria. Moreover, inactivation by circulating antibodies can reduce the efficacy of streptokinase [25].rTPA, a second-generation thrombolytic agent, was first identified and isolated from melanoma cells in 1980 [26]. It can bind to fibrin and ultimately stimulate plasminogen. Because it only acts in clots, it theoretically produces fewer systemic bleeding complications [4,25]. However, its high specificity for fibrin has only been observed in vitro [27]. A prospective randomized study has shown no difference in efficacy or safety between urokinase and rTPA [28].
Related Knowledge Centers
- Antithrombotic
- Arterial Embolism
- Fibrinolysis
- Hypotension
- Myocardial Infarction
- Pulmonary Embolism
- Allergy
- Pregnancy
- Thrombolysis
- Intravenous Therapy