Vnitr Lek 2003, 49(11):880-884

[Does streptokinase still have a role in the treatment of acute myocardial infarct?].

S Janousek: Interní kardiologická klinika Lékarské fakulty MU a FN Brno.

Streptokinase was discovered in 1933. Its importance has gradually grown since 1950's of the last century when it was used as the utterly first thrombolytic agent. Since the discovery that majority of acute myocardial infarctions is caused by thrombus in the area of ruptured endothel above the atherosclerotic platelet, it has become the first remedy able of real causal treatment of acute myocardial infarction (AMI). These days it becomes an obsolete remedy because of a range of disadvantages. Neutralizing antibodies for instance remain in organism for many years after its administration, which results in an inefficacious treatment. Moreover it causes allergic reactions or anaphylaxis in a part of population, hypotension, and decrease of its fibrinolytic effect after more then 3 hours after development of AMI. The most problematic is its anticoagulant effect lasting more than 24 hours after its administration and simultaneous increase in prothrombotic activity, which is a disadvantage if intervention treatment methods are appropriate (direct coronary angioplasty). The only advantage of streptokinase is its relatively low price. However, it cannot justify its use as a thrombolytic agent of the first choice and it is high time for it to be replaced in its treatment indications by plasminogen activator or by thrombolytic agents of the third generation derived from it, which can be conveniently administered in the bolus form.