Streptokinase

Chemical name

Enzyme protein from the cultures of the various strains of Streptococcus haemolyticus with molecular weight of about 5,000 dalton; Appears as liofilizirovannogo white powder

Of drugs

The drugs-fibrinoliticescoe. Activates fibrinoliz. Interfaces with plazminoguenom (profibrinolizinom) is the "aktiwatornyi Complex, catalytic conversion plazminoguena blood and blood clots in plazmin (fibrinolizin). Плазмин, with proteolytic enzyme activity is lysis thread фибрина blood clots, and the degradation of фибриногена etc. plasma proteins, including V (ackzelirin) and VII (convertin) factors such as blood clotting. Phlebo dissolves, both on the surface as well as from within. The most effective in fresh sgustkah fibrina (before retraktion); Clears the trombirovannah blood vessels. Inaguiruetsa circulating in the blood of antibodies. Therapeutic doses provide the necessary fibrinoliticescuu activity. The on / Infusion in the plasma fibrinoguena down for 24-36 h correlates with a decrease in blood viscosity and aggregation of platelets. The effect is a maximum 45 minutes, and giperfibrinoliz gradually declining, remains for a few hours, trombinovoe remains extended for the next 24 hours by increasing the number of circulating degradation products fibrinoguena and after Fibrina.t_1/2 in / in the 1.5 million IU-1 hour of стрептокиназа-плазми��оген - about 23 minutes. The inaguiruetsa (part) antistreptokokkovmi antibodies formed plazmin-circulating plasma inhibitors, including alfa-2-plazmina inhibitor and альфа-2-макроглобулин��м. Biotransformiroetsa in the liver by hydrolysis (metabolites are unidentified). Place in a small number of kidneys. In Hepatic Cl slowed; Kidney failure does not affect the Cl.v conditions / in Infusion reduces AD and round with a further decrease heart emissions and the improvement of the left heart (in the case of congestive heart failure); Increasing the number kollaterley reduces the frequency of deaths in the infarct occurred and episodes zagrudinna pain. In a intrakoronarnom trombolizis comes after one hour; Improved performance features heart, the number of tromboticeskih obstructive violations and deaths from pulmonary embolism artery.

Indications

Acute myocardial infarction (within the first 12 hours), tromboembolia pulmonary artery and its branches, coronary arteritis (acute, podostry and chronic), peripheral pulmonary artery thrombosis due to diagnostic and therapeutic procedures in children, including in the handling of the newborn, labor gemodializni shunt, in the coronary prosthesis heart valves; chronic obliteriruty endarteriit, chronic disease occluzie arteries retromboz after operations on the receptacles, obliteration arteriovenoznogo shunt, inflammatory central retinal vessels), venous thrombosis (acute coronary deep vein limbs and pelvis, podklucichnykh coronary veins or veins internal organs, retromboz after operations on the receptacles), the scene / in catheters, incl. for haemodialysis; mono or combination therapy pain relief (for acute myocardial infarct).

Contraindications

Hypersensitivity, bleeding (acute recently postponed, internal), bleeding and high risk of the outbreak (within 2 months after the disturbance of cerebral circulation, intracranial or spinal surgery; For a period of 10 days after delivery, arterial punction in / m injection organnah biopsi, injuries, including head), the recent multiple injuries tumours with a proclivity to bleeding, tumors of the brain or disease in the central nervous system and it erosivno-azwenne defeat stomach with bleeding for the past six months and chronic inflammatory diseases of the large bowel, including Baby Ulcerative Colitis, acute pancreatitis expressed uncontrolled arterial hypertension (AD more than 200/110 mm Hg), anevrizma, mitrale heart disease with brilliance predserdy acute pericardit, podostry bacterial endocardit, bloody diates and other defects in hemostasis, severe diabetic retinopathy active form of tuberculosis and other lung diseases accompanied by the formation of cavities, sepsis or septic thrombosis, posleoperazionny period (3-6 weeks, especially 8-12 days after extended surgery), within 4 weeks after translumbalna arteriografii, three months after acute haemorrhagic stroke; the first 18 weeks of pregnancy or pregnancy pathology at risk of hemorrhage (predlejanie placenta, etc.).

Side-Effects

Bleeding : from placing and mines, gums, liver, gastrointestinal, urogenital, retroperitoneale, etc.; Gap spleen, bleeding : skin, subcutaneous, in the pericardial (up to the gap attack), the brain (deaths), bruises; Reperfuzionnaya incredible (with myocardial infarct), necardiogenny black light (intrakoronarnoe introduction of the infarct attack) embolism (due to the mobilization of clot or fragmentation), incl. pulmonary artery (with tromboze deep vein), distal arteries (embolization selfishness by local trombolizise in peripheral arteries), stroke emboliceski increase Monday; in a multiple-plasma raising cium, level of AST, ALT, gamma-glutamiltranspeptidaza, alkaline phosphatase, kreatinkinaza, lower-cholinesterase, and the allergic reaction anaphylactoidnye (especially with the rapid introduction) : skin rash, urticaria, generalized exantema, itching, redness of skin, despnoe, bronhospazm, nausea, vomiting, increased b 98de ody temperature, fever, headache, pain in the spine and muscles, or bradi- tachycardia, a decline AD arthritis, vasculita (including hemorrhagic), jade, polineiropatia, periorbitalny angioneuroticeski and swelling, anaphylactic shock, etc.

Specific guidance

Finished solutions used within 12 hours (not more).

Patient interaction

Heparin, coumarin derivatives, dipiridamol, NPVS, incl. acetylsalicylic acid, dekstrana, valproeva acid increased protivosvertawati effects and increase the risk of bleeding. Incompatible with plazmozameshchatmi solutions - гидроксиэтилированны м krahmalom and dekstranom.

Overdosing

Symptoms : increased side effects, the most often-Krovotechenia.lechenie : with massive or uncontrolled internal bleeding, stop bleeding (if possible), the appointment of антифибринолитически х funds (tranexamova acid, �арааминометилбензой��ая acid kallickreina inhibitors or protease, including aprotinin, in the initial dose of 500,000 CIE, then 50000-100000 CIE / h in / in the drip, with massive hemorrhage; aminocaproic acid 5 g for 1 h, and then to 1 g / hr for 4-8 h before reaching effects, with an internal hemorrhage) krovopoteri substitution (except dextran and �идроксиэтилированно��о starch). Treating symptoms : when bradikardii Introduction atropine, pre-complications of atrial-ventricular defibrillace, allergies-appointment of glucocorticoids, fever, acetaminophen, a sharp hypotension due to the rapid introduction of the loss of speed Infusion, Lifted bottom of the body, the appointment of vazokonstrictorov. All activities carried out against a backdrop of the abolition of streptokinaza.

Precautions

Acute lysis control Determining trombinovoe or partial tromboplastinovoe time, the figures should be at least 2-4 or 1.5-2.5 normal values respectively. Long trombolizis evaluate in terms trombinovogo time, which increased by a factor of 2-4 through 6-8 h after lysis; In the case of an increase of more than four times, reduce the dose of 2 Raza.s pores apply expressed in human liver and kidneys, diabetes, bronchial asthma, postponed streptokokkova infection including rheumatologic bronhoektasiah with krovoharkanyem, varicose veins oesophagus, the recent appointment of anti, conditions after cardiopulmonary resuscitation (including indirect heart massage), IVL (intubation), artistic methods accompanying urological diseases, including urolitiaze, chronic digestive diseases, menorragiah, waiting artistic methods previously (5 days to 1 year) carried treatments streptokinazoy in old age (over 75 years). Prior to the introduction, if history upgraded subtitle antistreptokinaznah antibodies, including children (perhaps in the period from 5 days to 12 months after the first application, or after a postponed streptokokkova infection : pharyngitis, rheumatism, glomerulonefrit, etc.) are test sensitivity streptokinaze. The newborn and premature to announce the skull. At the beginning of infuziu out with a low rate, possibly by antigistaminnah and glucocorticoids to prevent allergic reactions. Before and during therapy every 4 h determine trombinovoe, partial tromboplastinovoe and protrombinovoe time fibrinoguena level. Patients with DVT deep vein receiving streptokinazou should not interrupt the reception contraceptives. The Puncture pressure at the time in / Infusion in preferred choice receptacles upper limbs (followed by the imposition of pressing bandages for 30 minutes (at least). To avoid retrombozov after each course, a further appointment anticoagulants (heparin 500 IU / h, then coumarin derivatives) or antiagregantov (especially acetylsalicylic acid). Not recommended systemic use in myocardial infarct after 24 hours or longer, with tromboze deep vein-14 days or longer, with tromboze receptacles retina : arterial occluzi 6-8 h or more venous-10 days or more, for chronic occluziah arteries, including obliterirutego endarteriita-6 weeks or more.

Dosing and Administration

B / drip in, if necessary intrakoronarno or / and (for the full and rapid dissolution liofilizat carefully avoiding shaking and flushing, mixed with 5 ml izotoniceski solution of sodium chloride or water for injection; Infuzionna to raise pump solutions : physiological, ringer lactate, gelatina, 5% glucose or lewouleza, for the big advances in the long introduction to gemakzel providing greater stability solution). Adults : with myocardial infarct (X coronary), in / in drip 1.5 million IU within 30-60 min (followed by heparin 1000 IU / h); By local UREALYTICUM vnutrikoronarnogo clot-intrakoronarno (through the catheter) 20,000 IU and then on the 2,000 IU / min, the total dose of 140,000 IU, in the 30-40 minutes, or 250000-300000 IU within 30-60 minutes (less than one hour introduction would not stop, although реканализация can develop faster); tromboze in peripheral arteries and veins : in the case of short-term trombolizisa in / in the drip, in a dose of 250,000 IU for 30 minutes, in the supporting-1.5 IU / h during 6900, as appropriate course repeat (but not later than the fifth day after the first course); in the case of long-trombolizisa 250,000 IU in / in the drip for 30 minutes and then to 1 million IU / h in the form of infusions, duration of 12 hours to 3-5 days (maximum); if necessary, continued therapy after a break and can be replaced for a homologous trombolitik. In tromboze deep vein thromboembolism and pulmonary artery in / with drip 250,000 IU for 30 minutes, then 100,000 IU / h for 72 h respectively pathology. In subacute and chronic trombozah and emboliah in / drip in the 1000-2000 IU (Infusion duration and the number of drug depends on the location and depth occluzii receptacle). To restore cross-kanuli 100000-250000 IU 2 ml sodium chloride slowly in each corked end; Procedure lasts two hours (and dirt from the kanuli). Children, including newborns in tromboze arteries as a result of the various procedures in / with drip 1000-10000 IU / kg body weight for 20 to 30 minutes, followed by a long (but not more than 5 days) in / in infuziei 1,000 IU / kg / h, pouring out when the pulse becomes palpiruemam or significant bleeding from the place of; If necessary, local lysis 50 IU / kg / h.

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