Description overdue on 03.06.2012

Fibrinolytic agents.   The principle is based on the impact of the active agent in contact with plasminogen, plasminogen forms a complex, which activates the transition fibrinolizina plasmin-fibrinolysin. The latter is a proteolytic enzyme, whereby there is a dissolution of fibrin fibers in clot and blood clots that cause degradation of fibrinogen, specific plasma proteins, coagulation factors and 7. 5 Streptokinase dissolves thrombi not only on the surface but also inside. The active ingredient of the drug is streptococcal protein which has antigenicity which can lead to the neutralization of streptokinase specific antibody. Accelerated fibrinolysis   It is achieved by the introduction of an excess amount of the drug sufficient for neutralizing antibodies .  Streptokinase is able to restore patency to an already damaged, thrombosed blood vessels .  The drug when administered intravenously is able to reduce peripheral vascular resistance and blood pressure, with a gradual decline in the IOC .  The drug improves the performance of the left ventricle in patients with chronic heart failure .  Myocardial infarction Streptokinase can significantly reduce the incidence of deaths with timely and correct application .  The drug is able to reduce the number of deaths in pulmonary embolism, reduce the number of thrombotic complications of diseases of the cardiovascular system, the medication improves the functional performance of the heart .  The fibrinolytic effect upon completion of the infusion has been observed for a few hours, and increased thrombin time is recorded to one day due to the simultaneous increase in the number of circulating degradation products of fibrinogen and fibrin, as well as lower fibrinogen .  Streptokinase capable of activating not only tissue fibrinolysis   (thrombolysis - the dissolution of a blood clot), and fibrinolysis system   (the process of splitting blood fibrinogen). This mechanism of action may lead to bleeding due to hypofibrinogenemia . Most often this occurs before the retraction, when fresh blood clots. The effect of thrombolysis in intracoronary administration has been observed for an hour. Streptokinase is produced as a lyophilisate.

Indications:

Streptokinase is applied on the first day after the acute myocardial infarction, arterial thrombosis, thromboembolism arteries pulmonary embolism , Pulmonary artery branches. The drug is used in the first 6-8 hours of occlusion of the central retinal vessels, peripheral arterial thrombosis in the acute, subacute and chronic course of the period. The drug used in arterial thrombosis Caused by the conduct of diagnostic, therapeutic procedures in children, in newborns - with thrombosis caused by catheterization. The drug is effective in deep vein thrombosis limb vein thrombosis of internal organs, retromboz   after surgery, thrombosis after heart valve replacement, thrombosis hemodialysis shunt . The drug is used during the combination therapy, monotherapy angina diagnosed with myocardial infarction in the acute stage, and while washing with intravenous catheters, such as hemodialysis.

Contraindications:

Streptokinase does not apply to hemorrhagic diathesis , Hemorrhages, aneurysms, recent multiple injuries, diseases of the large intestine inflammatory, with erosive and ulcerative lesions of the gastrointestinal tract, with the main substance of intolerance, with cancer pathology, metastases in the central nervous system in tumors that are prone to bleeding, arterial hypertension, acute pancreatitis , Diabetic retinopathy, active form TB , Lung cavities, with mitral heart disease, with pericarditis, endocarditis, septic thrombosis , Sepsis in the postoperative period, after the biopsy, neurosurgery, after hemorrhagic stroke, translyumbalnoy arteriography, pregnancy, postpartum, after abortion, after catheterization. In rheumatoid arthritis, asthma, renal disease and liver, menorrhagia, nefrourolitiaze after cardiopulmonary resuscitation after streptococcal infections, varicose veins of the esophagus, bronchiectasis with hemoptysis, recent anticoagulation, the elderly, with previous therapy with streptokinase after IVL drug streptokinase used with caution.

Side effect:

Streptokinase can cause bleeding in the skin, bleeding from the gums, from the injection site, bleeding in the brain , Pericardium, myocardium, hematoma, internal bleeding (retroperitoneal, urogenital, in the digestive tract), pulmonary edema noncardia genesis in the intracoronary administration, reperfusion arrhythmia , Splenic rupture, embolism due to fragmentation of the thrombus and thrombus immobilization, kapillyarotoksikoz, embolic stroke, increased liver enzymes, increased erythrocyte sedimentation rate, decreased cholinesterase activity, hyperbilirubinemia , Allergic reactions, dyspnea, generalized exanthema, urticaria, chills, pyrexia, bronchospasm Vasculitis, arthritis, heart rhythm disorders, drop in blood pressure, anaphylactic shock, myalgia, headache, hyperthermia, jade, angioedema . polyneuropathy .

Overdose:

Manifested massive bleeding.   It requires the use of emergency medicines antitrombinoliticheskih: aprotinin . kallikrein inhibitors . PABA . tranexamic acid . In the first hour it is recommended that administration of 5 grams of aminocaproic acid and then 4-8 hours administered 1 gram every hour to stop bleeding. It demands the restoration of blood loss by administering hydroxyethyl starch, dextran. Posindromnaya therapy is conducted against the backdrop of a complete cessation of the use of streptokinase.

Mode of application:

The drug is administered intravenously streptokinase, intracoronary, as well as intra- .  Before infusion lyophilisate gently mixed with water for injection, sodium chloride, avoiding the formation of foam .  The initial dosage for adults thrombosis perichericheski arranged veins and arteries for short-term lysis is administered streptokinase at a dose of 250 000 IU of intravenous drip for half an hour, then go to the infusion of supporting dose: every 6 hours for 1, 5 million IU every hour, for a series of poured not More 9mln .  ME .  Repeated infusions may the next day .  Prolonged thrombolysis administered within an hour intravenous infusion of 250 thousand units, then transferred to a dose of 1 million IU per hour during hour intravenous infusion for up to 5 days .  If necessary, uninterrupted therapy after 5 days of drug replaced by other homologous Thrombolytic .  To prevent the development of heparin used retrombosis .

Special instructions:

Ready solution of lifilizata streptokinase should be applied within 12 hours. During treatment requires periodic monitoring of blood coagulation every 4 hours: define thromboplastin time , Thrombin time. Patients with elevated antibody titer antistreptokinaznyh and children, a test for sensitivity to streptokinase. Newborn children should be holding ultrasound of the skull. Infusion therapy at the beginning is slow, 10 minutes prior to infusion for the prevention of possible use of antihistamine medications and methylprednisolone at a dose of 100-200 mg. Repeated administration of the likelihood of allergic reactions increases significantly. With deep vein thrombosis   during the period of treatment is not recommended to stop taking contraceptives in view of the high risk of menorrhagia . Intravenous infusion is preferable to be carried out in vessels of the upper limbs. Be sure the imposition of a pressure bandage for 30 minutes after the procedure. After infusion personnel must be prepared for possible bleeding.

Drug Interactions:

Acetylsalicylic acid , Dextran, dipyridamole, coumarin derivatives, heparin, valproic acid can increase the risk of bleeding, as well as enhance the effectiveness of the drug streptokinase. When using antifibrinolytic agents observed the opposite effect. The drug is completely incompatible with the Plasma substitutes drugs: dextran , Hydroxyethyl starch.