Skip to main content

Streptase Side Effects

Generic name: streptokinase

Medically reviewed by Drugs.com. Last updated on Oct 10, 2023.

Note: This document contains side effect information about streptokinase. Some dosage forms listed on this page may not apply to the brand name Streptase.

Applies to streptokinase: injectable powder for injection.

Hematologic

Hematologic side effects of streptokinase (the active ingredient contained in Streptase) (SK) have included minor and major bleeding. The risk of bleeding appears to be significantly increased when plasma fibrinogen levels fall below 250 mg/dl. Minor bleeding has occurred in up to 67% of patients, presenting as venipuncture or arterial cutdown site oozing, microscopic hematuria, hemoptysis, or hematemesis. Local bleeding usually has been controlled by manual compression for 20 to 30 minutes. Serious or major bleeding, including gastrointestinal, genitourinary, joint, retroperitoneal or intracerebral hemorrhage, has occurred in 0.3% to 6.0% of patients. Adjuvant heparin, but not aspirin, therapy appears to increase the risk of bleeding.

Intracranial hemorrhage in 0.1% to 1.0% of patients and rare cases of intramyocardial hemorrhage have been reported. Several fatalities due to intracranial or retroperitoneal hemorrhage have occurred during thrombolytic therapy.

Rare cases of embolization and anti-SK-mediated platelet aggregation during or after SK therapy have been reported. There is speculation that fibrinolysis could increase pericatheter thrombosis, which can result in local or distal thromboembolism.[Ref]

Predisposing risk factors for the development of intracranial hemorrhage during thrombolytic therapy for myocardial infarction have included body weight less than 70 kg, age greater than 65 years old, and preexisting anticoagulant therapy. The authors of GISSI concluded that the risk of hemorrhagic stroke is also directly related to Killip classification.

A meta-analysis of 30 studies dealing with proximal lower extremity deep vein thrombosis (DVT) has revealed the following relative risks for patients who received SK + heparin versus heparin alone: any major bleeding, 2.9; central nervous system (CNS) bleeding, 4.5; mortality from CNS bleeding, 4.0; pulmonary embolism (PE), 1.0; mortality from PE, 1.0; postphlebitic syndrome, 0.4.

The risk of hemorrhagic side effects from streptokinase can be minimized with patient selection. Major risk factors for intracranial hemorrhage have included known intracranial tumor, prior neurosurgery, stroke within the past six months, head trauma within the past month. Other significant risk factors included severe, uncontrolled hypertension, a remote stroke known not to be hemorrhagic, recent transient ischemic attacks, advanced age, and female gender.[Ref]

Hypersensitivity

In the 8,592 patients in the ISIS-2 trial who received SK there were no confirmed incidences of anaphylactic shock. The GISSI study 7 incidents of nonfatal anaphylactic reactions among 5,860 patients who had received SK (0.1%), though 99 patients (1.7%) had allergic reactions severe enough to discontinue therapy and another 42 (0.7%) were identified retrospectively. Skin testing immediately before SK therapy appears to be a practical, sensitive, and specific tool to help identify patients at risk for anaphylaxis.[Ref]

The overall incidence of hypersensitivity reactions to SK from the ISIS-2, GISSI-1 and GISSI-2 data ranged from 1.6% to 4.4%. Smaller studies have reported an incidence of 2% to 6%. Acute allergic reactions to SK ranged from minor dyspnea, urticaria, pruritus, flushing, nausea, headache, or musculoskeletal pain to severe anaphylaxis, bronchospasm, or periorbital or angioneurotic edema. SK-induced fever has been reported in 30% to 50% of patients. Severe acute hypersensitivity reactions have usually required discontinuation of therapy, antihistamines, and/or corticosteroids. In rare cases, adrenergic agents have been required to treat anaphylactic shock.[Ref]

Cardiovascular

Since cardiovascular side effects may be more likely among the population of patients in whom SK in indicated, a cause-and-effect relationship to the drug is not always clear. Transient hypotension has been reported during SK therapy in approximately 40% of patients (anterior or inferior wall MI). Hypotension has been associated with reperfusion, which has been associated with decreased in-hospital mortality. Reperfusion of the myocardium has resulted in arrhythmias in 80% of patients who experience reperfusion. The most common reperfusion arrhythmia is a transient accelerated idioventricular rhythm, which is typically clinically benign. Premature ventricular depolarizations during reperfusion do not necessarily predict severe ventricular arrhythmias.

Dyspnea, cyanosis, rare cases of hemorrhagic myocardial infarction, serious ventricular arrhythmias, hemopericardium, and death from cardiogenic shock have been associated with thrombolytic therapy, in general.

Rare cases of cholesterol embolization syndrome have been associated with SK and other thrombolytic agents.[Ref]

Cholesterol embolization, a rare syndrome that typically presents with painful ischemia or necrosis of the digits, myalgias, skin changes of livedo reticularis and often progresses to renal failure and death, has occurred. Other findings have included cyanosis, ulcers, gangrene of the hands and feet, myalgias, intestinal infarction or eosinophilia. The exact mechanism is not known, but is believed to be due to physical disruption of atheromatous plaques by lysis of platelet-fibrin thrombi.[Ref]

Renal

New or worsened renal impairment has been associated with SK-induced immune complex disease. Rare cases of mild and transient acute renal insufficiency with proteinuria without evidence of hypersensitivity have been described after SK therapy.[Ref]

The differential diagnosis of acute renal failure following SK therapy includes ischemic injury, immunologic injury, and postrenal obstruction. Ischemia may be due to low cardiac output or hypotension secondary to acute myocardial infarction (if present), a direct effect of SK, reperfusion-induced hypotension, or hemorrhagic shock. These conditions may cause acute tubular necrosis. Ischemia may also be due to emboli from mural thrombi (if present), cholesterol emboli syndrome, or myoglobinuria.

Immunologic injury to the kidney may be related to SK-induced serum sickness, Schonlein-Henoch purpura, or immune complex nephritis.

Retroperitoneal hemorrhage or ureter thrombosis during or following SK therapy can cause postrenal obstruction.[Ref]

Nervous system

Hemorrhagic stroke, a potentially serious nervous system side effect, has affected approximately 0.1% to 1.0% of patients. Extremely rare cases of Guillain-Barre syndrome have been associated with the use of SK.[Ref]

In one case of Guillain-Barre syndrome (GBS) associated with SK oligoclonal IgG bands in the cerebrospinal fluid and serum were shown to be specific for streptokinase. Clinical symptoms of GBS were thought to result from SK-antibody complex-mediated damage to the local blood-nerve barrier.[Ref]

Gastrointestinal

Gastrointestinal side effects have been rare. Hemorrhagic gastritis has been associated with the thrombolytic state. Nausea or vomiting has been reported during thrombolytic therapy. Unusual cases of hemorrhagic splenic rupture and subcapsular hepatic hematoma have occurred.[Ref]

Hepatic

Rare cases of SK-induced hepatic dysfunction have been reported . Some experts believe that mild, transient liver function test elevations indicative of cholestasis do not appear to be caused by toxic or allergic effects of SK itself, but by the high activities of the proteolytic enzymes, plasminogen activator and plasmin. Rare cases of jaundice have been reported.[Ref]

In a prospective study of 24 nonselected patients with peripheral arterial occlusions undergoing SK therapy, 18 had significant liver enzyme elevations typical of cholestasis and impaired hepatocellular integrity and function, but none became jaundiced.[Ref]

Musculoskeletal

Rare cases of musculoskeletal back pain have been reported. In some cases bleeding into the iliopsoas muscles was discovered, but in most reported cases, there was no evidence of allergy, aortic dissection, worsened myocardial infarction or retroperitoneal hemorrhage.[Ref]

Genitourinary

A genitourinary concern for menstruating women who are considered for thrombolytic therapy has been whether SK can safely be used during menses. The drug has been used safely during menses, perhaps because hemostasis of the uterine endothelium after the first day of menses depends on arteriolar vasoconstriction more than the formation of fibrin.[Ref]

Respiratory

Adult respiratory distress syndrome (ARDS) has been rarely associated with the use of SK. ARDS is a known complication of hypersensitivity to SK.[Ref]

Dermatologic

Dermatologic side effects have included rare cases of dermal microemboli. Some cases have progressed to dermal necrosis.[Ref]

Immunologic

SK is antigenic and may induce the formation of antibodies. Delayed hypersensitivity reactions may result in the development of immune complex disease, presenting as fever, vasculitic or purpuric rashes, abnormal renal and liver function tests, arthralgias, serum sickness, and/or a syndrome resembling adult respiratory distress syndrome. A case of SK-induced direct antiglobulin test-positive hemolysis has been reported.[Ref]

General

The production of the general body symptom, fever, has also been associated with urokinase, which is not antigenic. While the mechanism of fever is not known, this suggests that fever may be due to breakdown products of thrombi rather than to thrombolytic drugs.[Ref]

References

1. Renkin J, de Bruyne B, Benit E, Joris JM, Carlier M, Col J. Cardiac tamponade early after thrombolysis for acute myocardial infarction: a rare but not reported hemorrhagic complication. J Am Coll Cardiol. 1991;17:280-5.

2. Tisdale JE, Colucci RD, Ujhelyi MR, Kluger J, Fieldman A, Chow MS. Evaluation and comparison of the adverse effects of streptokinase and alteplase. Pharmacotherapy. 1992;12:440-4.

3. Hirsch DR, Goldhaber SZ. Bleeding time and other laboratory tests to monitor the safety and efficacy of thrombolytic therapy. Chest. 1990;97:s124-31.

4. LeBolt SA, Tisnado J, Cho SR. Treatment of peripheral arterial obstruction with streptokinase: results in arterial vs graft occlusions. AJR Am J Roentgenol. 1988;151:589-92.

5. Marx M, Levin DC. Coronary thrombolytic therapy: state of the art. AJR Am J Roentgenol. 1986;147:1-8.

6. Ott P, Eldrup E, Oxholm P, Vestergard A, Knudsen JB. Streptokinase therapy in the routine management of deep venous thrombosis in the lower extremities. A retrospective study of phlebographic results and therapeutic complications. Acta Med Scand. 1986;219:295-300.

7. Porter RS, DiPalma JR. Coronary artery thrombolysis: comparison of approved agents. Am Fam Physician. 1991;44:591-8.

8. Schneeman NJ, Stein EM. Thrombolytic therapy and gastrointestinal bleeding. Am Fam Physician. 1991;43:53-6,.

9. Kahn SE, Goldstein J, Cope C. Low-dose streptokinase therapy for Swan-Ganz catheter-induced thrombosis. Am Heart J. 1985;110:891-3.

10. Califf RM, Fortin DF, Tenaglia AN, Sane DC. Clinical risks of thrombolytic therapy. Am J Cardiol. 1992;69:a12-20.

11. Thery C, Bauchart JJ, Lesenne M, Asseman P, Flajollet JG, Legghe R, Marache P. Predictive factors of effectiveness of streptokinase in deep venous thrombosis. Am J Cardiol. 1992;69:117-22.

12. Rentrop KP, Cohen M, Hosat ST. Thrombolytic therapy in acute myocardial infarction: review of clinical trials. Am J Cardiol. 1984;54:e29-31.

13. Kennedy JW, Gensini GG, Timmis GC, Maynard C. Acute myocardial infarction treated with intracoronary streptokinase: a report of the Society for Cardiac Angiography. Am J Cardiol. 1985;55:871-7.

14. Seaberg DC, Generalovich T. Hemorrhagic compression of the phrenic nerve after streptokinase infusion. Am J Emerg Med. 1989;7:185-6.

15. Wiener RS, Ong LS. Streptokinase and splenic rupture. Am J Med. 1989;86:249.

16. Sunderraj P. Intraocular hemorrhage associated with intravenously administered streptokinase. Am J Ophthalmol. 1991;112:734-5.

17. Goldberg M, Colonna-Romano P, Babins NA. Emergency coronary artery bypass surgery following intracoronary streptokinase. Anesthesiology. 1984;61:601-4.

18. Collen D. Coronary thrombolysis: streptokinase or recombinant tissue-type plasminogen activator?. Ann Intern Med. 1990;112:529-38.

19. Lessler DS, Avins AL. Cost, uncertainty, and doctors' decisions. The case of thrombolytic therapy. Arch Intern Med. 1992;152:1665-72.

20. Willis SM, Bailey SR. Streptokinase-induced subcapsular hematoma of the liver. Arch Intern Med. 1984;144:2084-5.

21. Kao KJ, Hackel DB, Kong Y. Hemorrhagic myocardial infarction after streptokinase treatment for acute coronary thrombosis. Arch Pathol Lab Med. 1984;108:121-4.

22. Chan NS, White H, Maslowski A, Cleland J. Plasmacytosis and renal failure after readministration of streptokinase for threatened myocardial reinfarction. BMJ. 1988;297:717-8.

23. Haugeberg G, Bonarjee V, Dickstein K. Fatal intrathoracic haemorrhage after cardiopulmonary resuscitation and treatment with streptokinase and heparin. Br Heart J. 1989;62:157-8.

24. Berridge DC, Makin GS, Hopkinson BR. Local low dose intra-arterial thrombolytic therapy: the risk of stroke or major haemorrhage. Br J Surg. 1989;76:1230-3.

25. Meissner AJ, Misiak A, Ziemski JM, Scharf R, Rudowski W, Huszcza S, Kucharski W, Wislawski S. Hazards of thrombolytic therapy in deep vein thrombosis. Br J Surg. 1987;74:991-3.

26. Godley PJ, Bell RC. Major hemorrhage following administration of intrapleural streptokinase. Chest. 1984;86:486-7.

27. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987;76:142-54.

28. De Jaegere PP, Arnold AA, Balk AH, Simoons ML. Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors. J Am Coll Cardiol. 1992;19:289-94.

29. Vaughan DE, Kirshenbaum JM, Loscalzo J. Streptokinase-induced, antibody-mediated platelet aggregation: a potential cause of clot propagation in vivo. J Am Coll Cardiol. 1988;11:1343-8.

30. Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML. Thrombolysis in Myocardial Infarction (TIMI) Trial--Phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol. 1988;11:1-11.

31. Holmstrom M, Bratt G, Tornebohm E, Rhedin AS, Lockner D. Fatal pulmonary embolism caused by streptokinase treatment of deep venous thrombosis of the leg? J Intern Med. 1990;228:647-9.

32. Partanen HJ, Nieminen MS. Intracerebellar fatal haemorrhage after thrombolytic therapy of suspected non-Q-wave myocardial infarction. Lancet. 1990;336:883.

33. Rogers TK, Polacarz S, Channer KS, Morice AH. Cardiac rupture and fibrinolytic therapy. Lancet. 1990;336:259-60.

34. Mathiesen O, Grunnet N. Haemolysis after intravenous streptokinase. Lancet. 1989;1:1016-7.

35. Makhdoom ZA, MacLeod F, Holmes GK, Elliott S. Pain during streptokinase infusion. Lancet. 1992;340:1235.

36. Gillanders IA, Nakielny R, Channer KS. Spontaneous iliopsoas haemorrhage--an unusual complication of streptokinase therapy. Postgrad Med J. 1990;66:862-3.

37. Oldroyd KG, Hornung RS, Jones AM, Andrews NP, Dawes PT, Carson PH. Spontaneous haemarthrosis following thrombolytic therapy for myocardial infarction. Postgrad Med J. 1990;66:387-8.

38. Hyer SL, Soo SC, Taylor W, Nussey SS. Spontaneous haemorrhage into a pituitary tumour after streptokinase therapy. Postgrad Med J. 1993;69:244.

39. Graor RA, Risius B, Young JR, Geisinger MA, Zelch MG, Smith JA, Ruschhaupt WF. Low-dose streptokinase for selective thrombolysis: systemic effects and complications. Radiology. 1984;152:35-9.

40. Chesterman CN. Late adverse effects of streptokinase. Aust N Z J Med. 1992;22:106-8.

41. Ramsay DA, Penswick JL, Robertson DM. Fatal streptokinase-induced intracerebral haemorrhage in cerebral amyloid angiopathy. Can J Neurol Sci. 1990;17:336-41.

42. Goa KL, Henwood JM, Stolz JF, Langley MS, Clissold SP. Intravenous streptokinase. A reappraisal of its therapeutic use in acute myocardial infarction. Drugs. 1990;39:693-719.

43. Friedman HS. Thrombolytic therapy for acute myocaardial infarction: GUSTO criticized. N Engl J Med. 1994;330:504.

44. Nyamekye I, Beard J, Gaines P. The management of stroke during intraarterial thrombolysis. Br J Radiol. 1993;66:781-2.

45. Browse DJ, Torrie EP, Galland RB. Early results and 1-year follow-up after intra-arterial thrombolysis. Br J Surg. 1993;80:194-7.

46. Meneveau N, Bassand JP, Schiele F, Bouras Y, Anguenot T, Bernard Y, Schultz R. Safety of thrombolytic therapy in elderly patients with massive pulmonary embolism: a comparison with nonelderly patients. J Am Coll Cardiol. 1993;22:1075-9.

47. Birnbaum Y, Stahl B, Rechavia E. Spontaneous hemarthrosis following thrombolytic therapy for acute myocardial infarction. Int J Cardiol. 1993;40:289-90.

48. Toupin LR, Blanchard DG. Acute anuric renal failure: a complication of combined thrombolytic and antithrombotic therapy. Int J Cardiol. 1993;40:283-5.

49. O'Meara JJ, McNutt RA, Evans AT, Moore SW, Downs SM. A decision analysis of streptokinase plus heparin as compared with heparin alone for deep-vein thrombosis. N Engl J Med. 1994;330:1864-9.

50. Stringer KA. Beyond thrombolysis: other effects of thrombolytic drugs. Ann Pharmacother. 1994;28:752-6.

51. Broadway DC. Retrobulbar hemorrhage after intravenous streptokinase therapy. Ann Ophthalmol. 1994;26:124-5.

52. Product Information. Streptase (streptokinase). Astra-Zeneca Pharmaceuticals. 2001;PROD.

53. Eggers KA, Mason NP. Lingual haematoma following streptokinase therapy. Anaesthesia. 1994;49:922.

54. Marcus DM, Frederick AR. Streptokinase-induced tenon's hemorrhage after retinal detachment surgery. Am J Ophthalmol. 1994;118:815-7.

55. Kleiman NS, White HD, Ohman EM, Ross AM, Woodlief LH, Califf RM, Holmes DR, Bates E, Pfisterer M, Vahanian A, Topol EJ. Mortality within 24 hours of thrombolysis for myocardial infarction: the importance of early reperfusion. Circulation. 1994;90:2658-65.

56. Jervis P, Mason JDT, Jones NS. Streptokinase and facial haematoma. Postgrad Med J. 1995;71:114-5.

57. Wong FKM, Chan SK, Ing TS, Li CS. Acute renal failure after streptokinase therapy in a patient with acute myocardial infarction. Am J Kidney Dis. 1995;26:508-10.

58. Lebrazi J, Helft G, Abdelouahed M, Elalamy I, Mirshahi M, Samama MM, Lecompte T. Human anti-streptokinase antibodies induce platelet aggregation in an fc receptor (CD32) dependent manner. Thromb Haemost. 1995;74:938-42.

59. Morris AD, Ritchie C, Grosset DG, Adams FG, Lees KR. A pilot study of streptokinase for acute cerebral infarction. QJM. 1995;88:727-31.

60. Levine MN, Goldhaber SZ, Gore JM, Hirsh J Califf RM. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest. 1995;108 Suppl:s291-301.

61. Montgomery HE, Mcintyre CW, Almond MK, Davies K, Pumphrey CW, Bennett D. Rhabdomyolysis and multiple system organ failure with streptokinase. BMJ. 1995;311:1472.

62. Karnash SL, Granger CB, White HD, Woodlief LH, Topol EJ, Califf RM. Treating menstruating women with thrombolytic therapy: insights from the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO-i) trial. J Am Coll Cardiol. 1995;26:1651-6.

63. Grijseels EWM, Bouten MJM, Lenderink T, Deckers JW, Hoes AW, Hartman JAM, Vanderdoes E, Simoons ML. Pre-hospital thrombolytic therapy with either alteplase or streptokinase - practical applications, complications and long-term results in 529 patients. Eur Heart J. 1995;16:1833-8.

64. Hommel M, Cornu C, Boutitie F, Boissel JP, Viallet F, Bonnefoikyriacou D, Gayraud D, Kiegel P, Bissuel JPB, Driencourt JB, Rue. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med. 1996;335:145-50.

65. Donnan GA, Davis SM, Chambers BR, Gates PC, Hankey GJ, Mcneil JJ, Rosen D, Stewartwynne EG, Tuck RR. Streptokinase for acute ischemic stroke with relationship to time of administration. JAMA. 1996;276:961-6.

66. Dykewicz MS, Patterson R. Serum sickness from streptokinase. Am Heart J. 1988;115:1338-9.

67. Noel J, Rosenbaum LH, Gangadharan V, Stewart J, Galens G. Serum sickness-like illness and leukocytoclastic vasculitis following intracoronary arterial streptokinase. Am Heart J. 1987;113:395-7.

68. Tio RA, Voorbij RH, Enthoven R. Adult respiratory distress syndrome after streptokinase. Am J Cardiol. 1992;70:1632-3.

69. Dykewicz MS, McGrath KG, Davison R, Kaplan KJ, Patterson R. Identification of patients at risk for anaphylaxis due to streptokinase. Arch Intern Med. 1986;146:305-7.

70. Sleight P. Dangers of thrombolysis. BMJ. 1990;300:1076.

71. Smithson JE, Kennedy CT, Hughes S. A new skin lesion associated with intravenous streptokinase. BMJ. 1993;306:973.

72. White HD, Cross DB, Williams BF, Norris RM. Safety and efficacy of repeat thrombolytic treatment after acute myocardial infarction. Br Heart J. 1990;64:177-81.

73. Jones PB, Clague R, Freemont T. Acute inflammatory polyarthritis following streptokinase. Br J Rheumatol. 1990;29:402-3.

74. Patel A, Prussick R, Buchanan WW, Sauder DN. Serum sickness-like illness and leukocytoclastic vasculitis after intravenous streptokinase. J Am Acad Dermatol. 1991;24:652-3.

75. Clesham GJ, Terry HJ, Jalihal S, Toghill PJ. Serum sickness and purpura following intravenous streptokinase. J R Soc Med. 1992;85:638-9.

76. McGrath KG, Patterson R. Anaphylactic reactivity to streptokinase. JAMA. 1984;252:1314-7.

77. Barnham M. Hypersensitivity and streptokinase. Lancet. 1990;335:535.

78. Salem DN, Pauker SG. The need to identify patients who have received streptokinase therapy. N Engl J Med. 1991;324:1742.

79. Kelly MP, Bielawska C. Recurrence of a reactive arthritis following streptokinase therapy. Postgrad Med J. 1991;67:402.

80. Glassock RJ, Ritz E, Bommer J, Andrassy K, Waldherr R. Acute renal failure, hypertension and skin necrosis in a patient with streptokinase therapy. Am J Nephrol. 1984;4:193-200.

81. Siebert WJ, Ayres RW, Bulling MT, Thomas CM, Minson RB, Aylward PE. Streptokinase morbidity--more common than previously recognised. Aust N Z J Med. 1992;22:129-33.

82. Schweitzer DH, van der Wall EE, Bosker HA, Scheffer E, Macfarlane JD. Serum-sickness-like illness as a complication after streptokinase therapy for acute myocardial infarction. Cardiology. 1991;78:68-71.

83. Davies KA, Mathieson P, Winearls CG, Rees AJ, Walport MJ. Serum sickness and acute renal failure after streptokinase therapy for myocardial infarction. Clin Exp Immunol. 1990;80:83-8.

84. Davidson JR, Bush RK, Grogan EW, Boh LA, Graziano FM. Immunology of a serum sickness/vasculitis reaction secondary to streptokinase used for acute myocardial infarction. Clin Exp Rheumatol. 1988;6:381-4.

85. Thompson RF, Stratton MA, Heffron WA. Hypersensitivity vasculitis associated with streptokinase. Clin Pharm. 1985;4:383,.

86. Thayer CF, Whitmore CK. Comment: streptokinase-induced reactions. DICP. 1990;24:546-7.

87. Tisdale JE, Stringer KA, Antalek M, Matthews GE. Streptokinase-induced anaphylaxis. DICP. 1989;23:984-7.

88. Bednarczyk EM, Sherlock SC, Farah MG, Green JA. Anaphylactic reaction to streptokinase with first exposure: case report and review of the literature. DICP. 1989;23:869-72.

89. Green C. Antistreptokinase titres after topical streptokinase. Lancet. 1993;341:1602-3.

90. Birnbaum Y, Strasberg B, Rechavia E, Neuman Y, Stahl B. Acute renal failure following intravenous streptokinase infusion for acute myocardial infarction. West J Med. 1993;158:406-9.

91. Lynch M, Pentecost BL, Littler WA, Stockley RA. Why do patients develop reactions to streptokinase? Clin Exp Immunol. 1993;94:279-85.

92. Lee HS, Yule S, McKenzie A, Cross S, Reid T, Davidson R, Jennings K. Hypersensitivity reactions to streptokinase in patients with high pre- treatment antistreptokinase antibody and neutralisation titres. Eur Heart J. 1993;14:1640-3.

93. Cross DB. Should streptokinase be readministered? insights from recent studies of antistreptokinase antibodies. Med J Aust. 1994;161:100-1.

94. Gray MY, Lazarus JH. Iritis after treatment with streptokinase. BMJ. 1994;309:97.

95. Lantin JP, Gattesco S, Duclos A, Zanchi A, Schaller MD, Pecoud A, Aubert V. Anaphylactoid purpura like vasculitis following fibrinolytic therapy - role of the immune response to streptokinase. Clin Exp Rheumatol. 1994;12:429-33.

96. Cooper JP, Quarry DP, Beale DJ, Chappell AG. Life-threatening, localized angio-oedema associated with streptokinase. Postgrad Med J. 1994;70:592-3.

97. Fowler SF, Murray KM. Torsemide: a new loop diuretic. Am J Health Syst Pharm. 1995;52:1771-80.

98. Mcgrath K, Hogan C, Hunt D, Omalley C, Green N, Dauer R, Dalli A. Neutralising antibodies after streptokinase treatment for myocardial infarction: a persisting puzzle. Br Heart J. 1995;74:122-3.

99. Jennings K. Antibodies to streptokinase - once is enough. BMJ. 1996;312:393-4.

100. DiMuzio A, DiGuglielmo G, Feliciani C, DeLuca G, DiMuzio M, Uncini A. Inflammatory myopathy after intravenous streptokinase. Muscle Nerve. 1997;20:619-21.

101. Melin JA, De Coster PM, Renkin J, Detry JM, Beckers C, Col J. Effect of intracoronary thrombolytic therapy on exercise-induced ischemia after acute myocardial infarction. Am J Cardiol. 1985;56:705-11.

102. Ridker PM, Michel T. Streptokinase therapy and cholesterol embolization. Am J Med. 1989;87:357-8.

103. Zatuchni J. Postthrombolytic high-risk syndrome. Angiology. 1988;39:773-4.

104. Alexopoulos D, Collins R, Adamopoulos S, Peto R, Sleight P. Holter monitoring of ventricular arrhythmias in a randomised, controlled study of intravenous streptokinase in acute myocardial infarction. Br Heart J. 1991;65:9-13.

105. Richardson SG, Allen DC, Morton P, Murtagh JG, Scott ME, O'Keeffe DB. Pathological changes after intravenous streptokinase treatment in eight patients with acute myocardial infarction. Br Heart J. 1989;61:390-5.

106. Pirson Y, Honhon B, Cosyns JP, van Ypersele C. Cholesterol embolism in a renal graft after treatment with streptokinase. Br Med J (Clin Res Ed). 1988;296:394-5.

107. Blankenship JC, Almquist AK. Cardiovascular complications of thrombolytic therapy in patients with a mistaken diagnosis of acute myocardial infarction. J Am Coll Cardiol. 1989;14:1579-82.

108. Schwartz MW, McDonald GB. Cholesterol embolization syndrome. Occurrence after intravenous streptokinase therapy for myocardial infarction. JAMA. 1987;258:1934-5.

109. Pochmalicki G, Feldman L, Meunier P, Rougeot C, Weschler J, Jan F. Cholesterol embolisation syndrome after thrombolytic therapy for myocardial infarction. Lancet. 1992;339:58-9.

110. Cercek B, Horvat M. Arrhythmias with brief, high-dose intravenous streptokinase infusion in acute myocardial infarction. Eur Heart J. 1985;6:109-13.

111. Herlitz J, Hartford M, Aune S, Karlsson T. Occurrence of hypotension during streptokinase infusion in suspected acute myocardial infarction, and its relation to prognosis and metoprolol therapy. Am J Cardiol. 1993;71:1021-4.

112. Gemmill JD, Hogg KJ, Douglas JT, Dunn FG, Lowe GD, Rae AP, Hillis WS. The incidence and mechanism of hypotension following thrombolytic therapy for acute myocardial infarction with streptokinase-containing agents--lack of relationship to pretreatment streptokinase resistance. Eur Heart J. 1993;14:819-25.

113. RiveraManrique E, CastroSalomo A, AzonMasoliver A, Marin LM. Cholesterol embolism: A fatal complication after thrombolytic therapy for acute myocardial infarction. Arch Intern Med. 1998;158:1575.

114. Newby KH, Thompson T, Stebbins A, Topol EJ, Califf RM, Natale A. Sustained ventricular arrhythmias in patients receiving thrombolytic therapy - Incidence and outcomes. Circulation. 1998;98:2567-73.

115. Payne ST, Hosker HS, Allen MB, Bradbury H, Page RL. Transient impairment of renal function after streptokinase therapy. Lancet. 1989;2:1398.

116. Pickett TM, Hilton PJ. Proteinuria and streptokinase. Lancet. 1993;341:1538.

117. Lynch M, Pentecost BL, Littler WA, Stockley RA. Proteinuria with streptokinase. Lancet. 1993;341:1024.

118. Lang EK. Streptokinase therapy: complications of intra-arterial use. Radiology. 1985;154:75-7.

119. Birnbaum Y, Barash D, Rechavia E, Regev A, Stahl B, Mager A. Acute iritis and transient renal impairment following thrombolytic therapy for acute myocardial infarction. Ann Pharmacother. 1993;27:1539-40.

120. Zilliox AP, Domoto DT, Hutcheson PS, Tsai CC, Slavin RG. Henoch-Schoenlein purpura due to streptokinase. J Clin Immunol. 1993;13:415-23.

121. Birnbaum Y, Hasdai D, Stahl B. Renal adverse effects of streptokinase therapy. Int J Cardiol. 1994;46:1-6.

122. Lynch M, Hoffmann NV, Aroney CN. Thrombolytic treatment and proteinuria. Br Heart J. 1995;74:354-7.

123. Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G. The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), andThe International Study Group. N Engl J Med. 1992;327:1-6.

124. Collins R, Sleight P, Maggioni AP. The risk of stroke after thrombolytic therapy . N Engl J Med. 1992;327:1531-2.

125. Chrysanthopoulos C, Kounis N. Rhabdomyolysis due to combined treatment with lovastatin and cholestyramine. BMJ. 1992;304:1225.

126. Leaf DA, MacDonald I, Kliks B, Wilson R, Jones SR. Streptokinase and the Guillain-Barre syndrome. Ann Intern Med. 1984;100:617.

127. Arrowsmith JB, Milstien JB, Kuritsky JN, Murano G. Streptokinase and the Guillain-Barre syndrome. Ann Intern Med. 1985;103:302.

128. Maggioni AP, Franzosi MG, Farina ML, Santoro E, Celani MG, Ricci S, Tognoni G. Cerebrovascular events after myocardial infarction: analysis of the GISSI trial. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). BMJ. 1991;302:1428-31.

129. Kinshuck D. Bilateral hypopyon and streptokinase. BMJ. 1992;305:1332.

130. Aldrich MS, Sherman SA, Greenberg HS. Cerebrovascular complications of streptokinase infusion. JAMA. 1985;253:1777-9.

131. Kaiser R, Kaufmann R, Czygan M, Lang H, Lucking CH. Guillain-Barre syndrome following streptokinase therapy. Clin Investig. 1993;71:795-801.

132. Freimark D, Leor R, Hod H, Elian D, Kaplinsky E, Rabinowitz B. Impaired hepatic function tests after thrombolysis for acute myocardial infarction. Am J Cardiol. 1991;67:535-7.

133. Mager A, Birnbaum Y, Zlotikamien B, Strasberg B, Rechavia E, Sagie A, Sclarovsky S. Streptokinase-induced jaundice in patients with acute myocardial infarction. Am Heart J. 1991;121:1543-4.

134. Polkey MI, Oliver RM, Walker JM. Hepatic dysfunction induced by streptokinase. Am J Gastroenterol. 1992;87:1062.

135. Schmidt E, Schmidt FW. Streptokinase-induced hepatic dysfunction. Am J Gastroenterol. 1984;79:328-9.

136. Phillips E, Woolfrey S, Cameron E. Streptokinase-induced jaundice. Postgrad Med J. 1994;70:55.

137. Pipek R, Avizohar O, Levy Y. Transient hepatic dysfunction in two brothers receiving heparin and streptokinase: a genetic predisposition? Int J Cardiol. 1994;46:299-301.

138. Gilutz H, Cohn G, Battler A. Jaundice induced by streptokinase. Angiology. 1996;47:281-4.

139. Sood N, Midha V. Streptokinase-induced jaundice due to hemolysis in a G-6PD-deficient patient. Am J Gastroenterol. 2000;95:312-3.

140. Shah M, Taylor RT. Low back pain associated with streptokinase. BMJ. 1990;301:1219.

141. Mahadeva R, Siklos PW. Pain during streptokinase infusion. Lancet. 1992;340:1234-5.

142. Lear J, Rajapakse R, Pohl J. Low back pain associated with streptokinase. Lancet. 1992;340:851.

143. Simel DL, Moorman JR, Pryor SL, Piscitelli JT, Sharma GV. Is streptokinase safe during menses? Arch Intern Med. 1984;144:841-2.

144. Powers JC. Is menstruation a contraindication to thrombolytic therapy?. Clin Cardiol. 1992;15:875.

145. Kerstein MD, Adinolfi MF. Pulmonary dysfunction associated with streptokinase therapy. Arch Surg. 1986;121:852-3.

146. Penswick J, Wright AL. Skin necrosis induced by streptokinase. BMJ. 1994;309:378.

147. Abraham JS, Wilson M, Scripcariu V, Barnes PC, Marcuson RW. Microembolism from aortic aneurysm and ventricular thrombus: a complication of intravenous streptokinase. Postgrad Med J. 1994;70:756-8.

148. Juhlin P, Bostrom PA, Torp A, Bredberg A. Streptokinase antibodies inhibit reperfusion during thrombolytic therapy with streptokinase in acute myocardial infarction. J Intern Med. 1999;245:483-8.

149. Gorog DA, Ahmed N, Davies GJ. Platelet reactivity and streptokinase resistance following antecedent streptokinase therapy for myocardial infarction. Cardiology. 1999;91:56-9.

150. Chelluri L, Sirio CA, Angus DC. Thrombolytic therapy for acute myocardial infarction: GUSTO criticized. N Engl J Med. 1994;330:505.

151. Ogunyankin K. Thrombolytic therapy for acute myocardial infarction: GUSTO criticized. N Engl J Med. 1994;330:505.

152. Topol EJ, Califf RM, Van de Werf F. Thrombolytic therapy for acute myocardial infarction: GUSTO criticized. N Engl J Med. 1994;330:505-6.

153. Barletta JF. Streptokinase and urokinase for the treatment of pleural effusions and empyemas. Ann Pharmacother. 1999;33:495-8.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer