Streptokinase

When ATH:
B01AD01

Pharmacological action.
Fibrinolytic.

Application.

Acute myocardial infarction (during the first 12 no), pulmonary artery and its branches, arteryalnыy thrombosis (sharp, subacute and chronic), thrombosis of peripheral arteries, thrombosis due to diagnostic and therapeutic procedures in children, incl. catheterization in newborns, hemodyalyznoho shunt thrombosis, thrombosis in prosthetic heart valves; chronic occlusive disease, chronic occlusive arterial disease, retromboz after angioplasty, obliteration arteriovenoznogo shunt, occlusion of the central retinal vessels), vein thrombosis (acute deep venous thrombosis of limbs and pelvis, thrombosis of the subclavian vein or veins of the internal organs, retromboz after angioplasty), washing / in catheter, incl. Hemodialysis; mono- or combination therapy of angina at rest (in acute myocardial infarction).

Contraindications.

Hypersensitivity, bleeding (sharp, recently transferred, internal), bleeding and a high risk of their occurrence (during 2 months after the disturbance of cerebral circulation, intracranial or spinal surgery; during 10 days after childbirth, arterial punctures, i / m injection, organ biopsy, injuries, including cranial), recent multiple injuries, tumors with a tendency to bleeding, brain tumors or metastases in the CNS, erosive and ulcerative lesions gastrointestinal bleeding within the last 6 months and chronic inflammatory bowel disease, including ulcerative colitis, acute pancreatitis, severe uncontrolled hypertension (HELL more 200/110 mm Hg. Art.), aneurysm, mitral valvular heart disease with atrial fibrillation, acute pericarditis, subacute bacterial endocarditis, gyemorragichyeskii diatyez E Dr.. defects in hemostasis, tyazhelaya diabeticheskaya retinopathy, active form of tuberculosis, etc.. lung diseases, accompanied by the formation of cavities, sepsis or septic thrombosis, postoperative period (3-6 Sun, particularly 8-12 days after extended surgeries), during 4 weeks after translyumbalnoy arteriography, 3 months after acute hemorrhagic stroke; first 18 weeks of gestation or pregnancy pathology with an increased risk of bleeding (placenta previa, and others.).

Side effects.

Bleeding: from the injection site and cuts, right, liver, gastrointestinal, urogenital, retroperitoneal and others.; splenic rupture, hemorrhage: Skin, subcutaneous, in the pericardium (until myocardial rupture), brain (Fatal), hematoma; reperfusion arrhythmia (myocardial infarction), non-cardiogenic pulmonary edema (intracoronary administration in myocardial infarction), thromboembolism (in connection with the mobilization of a blood clot or fragmentation), incl. pulmonary embolism (deep vein thrombosis), the distal portions of the artery (cholesterol embolization during local thrombolysis in peripheral arteries), embolic stroke, increased erythrocyte sedimentation rate; at repeated imposing-plasma raising cium, IS aktivnosti, GOLD, Gamma glutamyl, Alkaline phosphatase, creatine, decline-cholinesterase, Allergic and anaphylactoid reactions (especially with the rapid introduction): skin rash, hives, generalized rash, itch, erythema, dyspnoea, bronchospasm, nausea, vomiting, fever, chills, headache, pain in the spine and muscle, Beards- or tachycardia, decrease in blood pressure, arthritis, vasculitis (incl. haemorrhagic), nephritis, polyneuropathy, and periorbital angioedema, anaphylactic shock, etc..

Cooperation.

Heparin, coumarin derivatives, dipiridamol, NSAIDs, incl. acetylsalicylic acid, dekstranы, valproic acid enhance the anticoagulant effect and increase the risk of bleeding. Incompatible with finding solutions — gidroksijetilirovannym starch and dextran.

Overdose.

Symptoms: increased side effects, most often the bleeding.

Treatment: When massive uncontrolled internal bleeding or stop bleeding (possibly), appointment of antifibrinolytic agents (tranexamic acid, paraaminometilbenzoynaya acid, kallikrein inhibitors or protease, incl. aprotinin-primary dose 500000 KIE, then 50000-100000 KYA/h in/in drip — when massive bleeding; Aminocaproic acid- 5 d for 1 no, then 1 g/h for 4-8 hours to achieve the effect — when internal bleeding), replacement of blood loss (except dextran and hydroxyethyl starch). Symptomatic treatment: When bradikardii introduction atropine, arrhythmia-complications, Ventricular fibrillation-defibrillation, allergies-appointment of glucocorticoids, fever — paracetamol, sharp hypotension due to the rapid introduction, lowering speed infusion, elevated position of the lower body, appointment of vasoconstrictor. All activities carried out against the backdrop of the abolition of streptokinase.

Dosing and Administration.

B / drop, if necessary - intrakoronarno or B / A (for the full and rapid dissolution of the lyophilisate carefully, avoiding shaking and foaming, mixed with 5 ml izotoniceski solution of sodium chloride or water for injection; infusion pump for diluted solutions: physiological, Ringer's lactate, gelatin, 5% glucose or levulose, for large dilutions in the long-term administration is recommended gemaktsel, solution provides greater stability). Adults: myocardial infarction (coronary thrombosis) — in/in the drip 1500000 IU within 30-60 minutes (followed by heparin 1000 IU/h); local lizise vnutrikoronarnogo blood clot — intrakoronarno (through the catheter) 20000 ME, then the 2000-4000 IU/min, total dose 140000 ME, for 30-40 minutes, or 250000-300000 IU within 30-60 minutes (earlier than 1 h introduction do not stop, Although recanalization may develop faster); thrombosis of peripheral arteries and veins: in the case of short-term trombolizisa in/in drip-, at an initial dose 250000 IU for 30 m, in supporting — 1500000 IU/h during 6 no, If necessary, repeat (but not later than the fifth day after the first course); in the case of long-trombolizisa 250000 IU in/in drip for 30 m, then on 1000000 IU/h in the form of infusions, duration from 12 h to 3-5 days (no more); If necessary, continued therapy after the break and with the possible replacement of the psbo trombolitik. In tromboze deep vein thromboembolism and pulmonary artery is in/in the drip 250000 IU for 30 m, then 100000 IU/h for 24-72 h respectively pathology. In subacute and chronic trombozah and emboliah-in/with drip 1000-2000 IU (duration of infusion and the amount of drug depends on the location and depth of the vessel occlusion). Cannula patency for recovery-100000-250000 IU 2 ml solution of sodium chloride, slowly at the end of each sealed; the procedure lasts 2 no (followed by aspiration of the contents of the cannula). Babies, incl. newborn, in tromboze arteries as a result of the various procedures — in/with drip 1000-10000 IU/kg body weight for 20-30 min, followed by long-term (but not more 5 days) in/in infuziei 1000 IU/kg/h, the infusion is stopped, when the pulse becomes palpable or significant bleeding from the injection site; If necessary, local Lysis 50 IU/kg/h.

Precautions.

Short-lysis control, determining thrombin or partial thromboplastin time, indicators should be at least 2-4 or 1.5-2.5 normal values, respectively. Long thrombolysis was assessed by thrombin time, that increases in 2-4 times through 6-8 h after Lysis; in case of an increase of more than 4 times, reduce the dose 2 times.

With extreme caution is used when expressed violations of the liver and kidneys, diabetes, asthma, streptococcal infection, including rheumatism, bronchiectasis with hemoptysis, esophageal varices, the recent appointment of anticoagulants, states after cardiopulmonary resuscitation (including chest compressions), IVL (Intubation), bleeding, accompanying urological diseases, incl. urolithiasis, chronic diseases of the gastrointestinal tract, menorrhagia, menstrual bleeding, earlier (from 5 days before 1 year) The courses of treatment with streptokinase, in old age (above 75 years).

Prior to the introduction, If a history of elevated antibody titer antistreptokinaznyh, incl. children (it is possible in the period from 5 days before 12 months after the first application or after streptococcal infection: pharyngitis, rheumatism, glomerulonephritis and the like.) conduct a test for sensitivity to streptokinase. In newborns and premature cranial ultrasound is recommended. At the beginning of infuziu out with low speed, the appointment antigistaminnah and glucocorticoids to prevent allergic reactions. Before and during therapy, every 4 h define Thrombin, partial thromboplastin and prothrombin time, Fibrinogen level. Patients with deep vein thrombosis, receiving streptokinazu, should not interrupt the reception contraceptives. If necessary, the puncture of a vessel during the on/in infusion is the preferred choice of vessels of upper limbs (with the subsequent imposition of a pressing bandage on 30 m (no less). To avoid retrombozov after each course requires additional appointment of anticoagulants (heparin 500-1000 IU/h, then coumarin derivatives) or antiplatelet agents (especially acetylsalicylic acid). It is not recommended to use the system in myocardial infarct after 24 h or more, in tromboze deep vein — 14 days or more, When thrombosis of retinal vessels: arterial occlusions — 6-8 hours or more, venous — 10 days or more, chronic treatment of arteries, incl. obliterating endarteritis — 6 weeks or more.

Cautions.

Finished solutions used during 12 no (no more).