Streptokinase

Intravenous drip, intraarterial, intracoronary.

Intravenously (to dissolve the lyophilisate, gently mix, avoiding foaming, with 5 ml of 0.9% sodium chloride solution, water for injection or with Ringer's solution).
For adults
For short lysis in peripheral arterial or venous thrombosis

Introduce intravenously at an initial dose of 250000 ME (within 30 minutes), and then maintenance doses of 1500000 ME every hour for 6 hours, the maximum dose per cycle is 9000000 ME. It is possible to repeat 6 hours of introduction, which is held no later than 5 days from the moment of the first course In the case of prolonged thrombolysis - 250000 ME intravenous drip for 30 minutes, then 100,000 IU / h in the form of an infusion lasting from 12 hours to 3-5 days (no more). If necessary, continue therapy after the break and with possible replacement with another homologous thrombolytic agent.

With thrombosis of coronary vessels

Intravenous drip 1500000 ME for 60 minutes followed by the introduction of heparin at a dose of 1000 IU / h. The effect is controlled by determining the thrombin or partial thromboplastin time. For long-term lysis in peripheral vascular thrombosis, 250000 ME is administered over 30 minutes. Maintenance dose is 100,000 IU / h. When this is achieved a 2-4-fold increase in thrombin time after 6-8 h after the start of lysis. Plasma fibrinogen should not be less than 1 g / l. If after a few hours the thrombin time increases by more than 4 times, the maintenance dose should be reduced by 2 times and applied until the thrombin time indicator again stabilizes in the above range.

For lysis of intracoronary thrombus

Intracoronary (using a catheter) 20,000 IU, then 2,000–4,000 IU / min, a total dose of –140,000 IU, for 30–40 min, or 2,500,000–3,000,000 ME for 30–60 min are administered. Introduction is not stopped earlier than 1 hour, although recanalization may develop faster.


For children

Enter intravenously in a dose of 1000-10000 IU / kg for 20-30 minutes, followed by a long infusion of 1000 IU / kg / h. Administration is stopped when significant bleeding is observed at the site of administration. For the prevention of retrombosis prescribe heparin. The duration of treatment should not exceed 5 days.

Patients with acute, subacute. chronic peripheral thrombosis and embolism

Enter 1000-2000 ME at intervals of 3-5 minutes. The duration and number of injections depend on the localization and depth of vessel occlusion, the maximum is 120000 ME in 3 hours. Simultaneous angioplasty is possible.

Local thrombolysis in acute, subacute and chronic thrombosis and embolism of peripheral arteries

Intra-arterial dose of 1000-2000 ME at intervals of 3-5 minutes to achieve the effect. The total dose should not exceed 120000 ME.

With deep vein thrombosis and pulmonary thromboembolism

Intravenous drip 250000 ME for 30 minutes, then 100,000 IU / h for 24-72 hours in accordance with pathology.

To restore the patency of the cannula

100000-250000 ME in 2 ml of sodium chloride solution, slowly in each closed end. The procedure is carried out for 2 hours followed by suction of the contents from the cannula.

The drug is contraindicated in the first 18 weeks of pregnancy.

Prepared solutions should be used within 12 hours. Periodic (with an interval of 4 hours) control of blood clotting is necessary: ​​thrombin or partial thromboplastin time (to avoid vascular reocclusion allows an increase in thrombin time 2-4 times, and partial thromboplastin 1.5 -2.5 times: with this in mind, you must enter the appropriate amount of heparin - 500-1 OOO IU / h, and then oral coumarin derivatives). Before administration to children and patients with a history of increased titer of antistreptokinase antibodies, they are tested for sensitivity to streptokinase. In newborns, an ultrasound examination of the skull is recommended. At the beginning of treatment, the infusion should be carried out at a low rate, with the prophylactic purpose it is possible to administer 100-200 mg of methylprednisolone 10 minutes before the administration, and antihistamines. Repeated administration of streptokinase increases the risk of allergic reactions. During the treatment period for deep vein thrombosis, patients should not interrupt the use of contraceptives in order to avoid the development of menorrhagia. After 5 days of treatment and for 1 year after the end of therapy, after suffering a streptococcal infection, the likelihood of resistance development is high, due to the appearance of a high titer of anti-streptococcal antibodies. If you need thrombolytic therapy in this case, you can use other fibrinolytics (urokinase, etc.). For intravenous administration, vessels of the upper extremities are preferred; after the procedure - the imposition of a pressure bandage for 30 minutes, with subsequent monitoring, due to possible bleeding (not to be administered within 10 days after arterial puncture and intramuscular injection).