Abstract
Streptokinase is the thrombolytic therapy of choice for acute myocardial infarction in hospitals without cardiac facilities. Streptokinase‑induced hypotension is one of the common adverse drug reactions and is usually observed within 30 min of an intravenous streptokinase infusion. The present study aimed to identify predictive clinical parameters for the development of hypotension in patients with acute myocardial infarction. The present retrospective study involved data transcription from National Indicator Approach (NIA) records of acute myocardial infarction recorded between 2015 to 2018. Multivariate analysis was performed to evaluate potential predictors of streptokinase‑induced hypotension and to determine the association between selected clinical variables in patients with streptokinase‑induced hypotension. The present study included a total of 412 patients with acute myocardial infarction administered streptokinase. The majority (n=258, 62.6%) did not develop any complication from the therapy, whereas 109 (26.5%) developed hypotension at 18.5 (interquartile range, 10.00) min from the initiation of therapy. Multiple logistic regression analysis revealed that with every one‑unit increment in the baseline heart rate, the risk of hypotension was reduced by 2.6%. Additionally, patients classified as Killip class III and IV were at an increased risk (5‑fold) of developing hypotension as compared with those classified as Killip I. Therefore, as demonstrated herein, these predictive factors may assist clinicians in identifying susceptible individuals and may encourage vigilance when delivering streptokinase therapy.
Highlights
Streptokinase is a protein harvested from β‐hemolytic Streptococci [1]
Hypotension with streptokinase therapy is commonly attributed to the non‐specific effect of streptokinase, as it activates the clot‐derived plasminogen, and the circulating plasma plasminogen, resulting in systemic fibrino‐ lysis and fibrinogenolysis [3]; its uses is associated with the occurrence of hypotension and bleeding tendencies [4,5,6]
The Killip classification quantifies the severity of heart failure following acute myocardial infarction as follows: Killip class I refers to no evidence of heart failure; class II refers to signs of suggestive of mild‐to‐moderate heart failure, such as the presence of S3 gallop and distended jugular veins; class III refers to overt pulmonary edema, and class IV refers to cardiogenic shock [8]
Summary
Streptokinase is a protein harvested from β‐hemolytic Streptococci [1]. Hypotension with streptokinase therapy is commonly attributed to the non‐specific effect of streptokinase, as it activates the clot‐derived plasminogen, and the circulating plasma plasminogen, resulting in systemic fibrino‐ lysis and fibrinogenolysis [3]; its uses is associated with the occurrence of hypotension and bleeding tendencies [4,5,6]. Streptokinase‐induced hypotension has been the subject of interest since the 1970s. The exact mechanisms responsible for its development remain obscure [7]. The present study aimed to predict the occur‐ rence of streptokinase‐induced hypotension from selected baseline clinical parameters in order to aid the identification of patients with acute myocardial infarction who are at risk of developing hypotension during streptokinase therapy
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