Current Clinical Experience with Staphylokinase in Arterial Thrombosis.

Abstract

Sak, a profibrinolytic agent produced by S. aureus that is now readily available by recombinant DNA technology, induces efficient and rapid recanalization in patients with occlusive arterial thrombosis. Its fibrin specificity at clinically effective doses by far exceeds that of any commercially available plasminogen activator. Likewise, the speed and rate of clot lysis compare favorably with established agents, but definition of the relative benefits, especially in terms of reduction of mortality and morbidity, awaits larger comparative trials. The optimal dose and rate of infusion in patients with coronary and peripheral arterial thrombosis, as well as the value of Sak in other thromboembolic disorders (comprising deep venous thrombosis, pulmonary embolism, and ischemic stroke), remain to be established. Notwithstanding its short circulatory half-life, bolus thrombolysis with Sak appears to be feasible. The antigenicity of wild-type Sak argues against repeated administration, but limited experience with selected recombinant mutants indicates that the immunoreactivity and antigenicity of this bacterial protein can at least be attenuated while preserving fibrinolytic activity and fibrin specificity.