Streptokinase: A review

This article summarizes the recent literature regarding the use of streptokinase in acute myocardial infarction (MI) and other thrombotic disorders, including pulmonary embolism, deep venous thrombosis, acute arterial thrombosis, and prosthetic valve thrombosis. This article reviews the recent data from three large randomized clinical trials comparing streptokinase and tissue-type plasminogen activator (t-PA) in the treatment of acute MI. This review suggests that streptokinase is the treatment of choice in nonanterior MIs and in elderly patients (age ≥75) who are presenting with an acute MI. There is no absolute or relative mortality reduction gained by use of t-PA instead of streptokinase in these settings, and the hemorrhagic stroke rate is lower with streptokinase therapy. Furthermore, this review reiterates the importance of adjunct therapy in the treatment of acute MI, including the use of aspirin, heparin, β-blocking agents, angiotensin-converting enzyme inhibitors, and hepatic hydroxy- methylglutaryl coenzyme A reductase inhibitors. Finally, the role of streptokinase therapy in the treatment of pulmonary embolism, acute arterial occlusion, acute deep venous thrombosis, and prosthetic valve obstruction is discussed. In summary, streptokinase is an effective and safe fibrinolytic agent that can be utilized in the hospitalized patient to reduce the modality and morbidity associated with a variety of medical conditions.