Streptokinase Therapy Research Articles

Streptokinase or Alteplase for Acute Limb Ischemia? A Meta-Analysis

Background: Acute limb ischemia (ALI) is a vascular emergency that necessitates prompt and effective treatment to restore blood flow and prevent limb loss. Thrombolytic therapy, particularly with agents like streptokinase and alteplase, plays a pivotal role in ALI management. This meta-analysis and systematic review aimed to compare the efficacy and safety of streptokinase and alteplase in treating ALI. Methods: A comprehensive search of PubMed, Embase, Science Direct, and the Cochrane Library databases was conducted up to August 13, 2024, to identify relevant studies. The inclusion criteria encompassed clinical trials involving patients diagnosed with ALI who received either streptokinase or alteplase as the initial thrombolytic treatment. The quality of the included studies was rigorously assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Methodological Index for Non-Randomized Studies (MINOR) criteria. A meta-analysis was performed using the Mantel-Haenszel random-effects model to calculate risk ratios (RRs) with their corresponding 95% confidence intervals (CIs). Results: The final analysis included 20 studies, encompassing both qualitative and quantitative assessments. A comparative analysis of streptokinase and alteplase for limb salvage at 30 days revealed a significant advantage in favor of alteplase, with a relative risk ratio (RR) of 0.78 (95% CI 0.69-0.88, I² = 0%). Furthermore, streptokinase was associated with a higher rate of primary amputation, with an RR of 2.54 (95% CI 1.50-4.32, I² = 0%) compared to alteplase. The use of streptokinase also correlated with a higher risk of complications, including major bleeding (RR 1.75, 95% CI 0.04-84.30, I² = 77%) and minor bleeding (RR 1.41, 95% CI 0.60-3.32, I² = 0%). Conclusion: The findings of this meta-analysis underscore the superior efficacy of alteplase in achieving limb salvage in ALI, coupled with a more favorable safety profile. The preferential use of alteplase in clinical practice is recommended, particularly in patients with severe ischemia. However, careful patient selection and close monitoring are crucial when streptokinase therapy is considered.

Massive Pulmonary Hemorrhage As A Complication of Intrapleural Streptokinase Therapy

Massive Pulmonary Hemorrhage As A Complication of Intrapleural Streptokinase Therapy

EFFICACY OF INTRAPLEURAL STREPTOKINASE IN RETAINED HEMOTHORAX

Retained hemothorax is a challenging clinical entity characterised by the accumulation of blood within the pleural cavity following chest trauma or surgery. In recent years, intrapleural streptokinase has emerged as a potential therapeutic option for managing retained hemothorax, offering a less invasive alternative to surgical interventions. However, limited data are available on the efficacy of this treatment modality in the Pakistani population. Objective: This study aimed to evaluate the effectiveness and safety of intrapleural streptokinase in resolving retained hemothorax among patients in Pakistan. Methods: A prospective observational study was conducted at a Rawalpindi Teaching Hospital in Pakistan from January 2022 to July 2023. One hundred patients meeting the inclusion criteria were enrolled in the study. Baseline demographic and clinical data were recorded, and intrapleural streptokinase therapy was administered according to standard protocols. Response to treatment was assessed through regular clinical examinations and radiological imaging over a predetermined duration. Descriptive statistics were used to summarise baseline characteristics, and inferential statistics, such as chi-square tests or t-tests, were utilised to compare outcomes between subgroups. Results: Of the 100 patients treated with intrapleural streptokinase therapy, 85% achieved successful resolution of retained hemothorax, as evidenced by complete drainage of blood from the pleural cavity and radiological confirmation of lung re-expansion. A subset of patients who did not respond to therapy required additional surgical interventions. Minor complications were observed in 10% of the study population. Conclusion: Intrapleural streptokinase therapy demonstrated promising outcomes in resolving retained hemothorax among patients in Pakistan. Despite the need for additional surgical interventions in some cases, this treatment modality's overall efficacy and safety profile supports its consideration as a first-line therapy for retained hemothorax in resource-limited settings.

Association of Increased Neutrophil to Lymphocyte Ratio to in-Hospital Outcome of Acute anterior Myocardial Infarction Patients Subjected to Thrombolytic Therapy with Streptokinase

Background: Myocardial infarction mainly contributes to morbidity and mortality around the globe. Thrombolytic therapy with streptokinase is the primary treatment strategy for patients with the presentation of ST-segment-elevated acute myocardial Infarction. Objective: To assess to assess the correlation between increased NLR and in-hospital outcome in acute anterior MI patients subjected to streptokinase therapy. Material and Methods: The study was a retrospective cohort conducted over a period of six months from 01, 06, 2021 to 30, 11, and 2021. All the patients admitted consecutively during this period received streptokinase therapy. The patients were grouped with respect to NLR, i.e., high NLR ang low NLR. The cut-off point for dividing into these two groups was set as 4.50 as an average of studies previously conducted. The study endpoints in-hospital outcomes and the secondary end point was short-term mortality.Results: A total of 250 patients were presented with acute MI. Complications were reported in 115 patients (46%) whereas 46 deaths (18.4%) were reported. More complications were reported in patients present in the group with higher NLR, (n=83 vs. 27, 62.8 % vs. 22.8 %, p <0.0001), as well as death (n=35 vs. 11, 26.5 % vs. 9.3 %, p<0.0001) in hospital compared to the group with lower NLR. Conclusion: high NLR (using 4.50 as cut-off value) is in association with a higher rate of complicatxions and death during stay in the hospital in acute MI patients which are subjected to streptokinase. Key Words: Myocardial infarction, Thrombolytic therapy, Streptokinase, Neutrophil, Lymphocyte.

Evaluation of Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction with Hypertension by Dynamic Electrocardiogram Feature Data

This work was to study the application value of dynamic electrocardiogram (ECG) feature data in evaluating the curative effect of percutaneous coronary intervention in acute ST-segment elevation myocardial infarction with hypertension, so as to facilitate the early diagnosis and treatment of the disease. In this study, 90 patients with acute ST-segment elevation myocardial infarction accompanied by hypertension were selected as the study subjects and randomly divided into group A (oral aspirin antiplatelet therapy), group B (thrombolytic drug streptokinase (SK) therapy), and group C (percutaneous coronary intervention), with 30 cases in each group. In addition, a P-wave detection algorithm was introduced for automatic detection and analysis of electrocardiograms, and the efficacy of patients was assessed by Holter feature data based on the P-wave detection algorithm. The results showed that the diagnostic error rate, sensitivity, and predictive accuracy of the P-wave detection algorithm for ST-segment elevation myocardial infarction caused by acute occlusion of left main coronary artery (LMCA) were 0.24%, 95.41%, and 92.33%, respectively; the diagnostic error rate, sensitivity, and predictive accuracy for non-LMCA (nLMCA) ST-segment elevation myocardial infarction were 0.28%, 95.32%, and 96.07%, respectively; the proportion of patients with symptom to blood flow patency time <3 h in group C (55.3%) was significantly higher than that in groups A and B (22.1% and 22.6%) ( P < 0.05). Compared with group A, the content of B-type natriuretic peptide (pre-proBNP) at 1 week, 2 weeks, and 3 weeks after treatment in groups B and C was significantly lower and group C was significantly lower than group B ( P < 0.05). In summary, the P-wave detection algorithm has a high application value in the diagnosis and early prediction of acute ST-segment elevation myocardial infarction. Percutaneous coronary intervention in the treatment of acute ST-segment elevation myocardial infarction with hypertension can shorten the opening time of infarction blood flow, so as to effectively protect the heart function of patients.

Efficacy of video-assisted thoracoscopic surgery versus intrapleural streptokinase for treatment of parapneumonic empyema with multiloculation and septation.

IntroductionEffective treatment of parapneumonic empyema with multiloculation and septation has been a challenge for clinicians for many years.AimThis study compared the clinical outcomes of video-assisted thoracoscopic surgery (VATS) and intrapleural streptokinase in patients with stage II empyema.Material and methodsThis is a retrospective study of 46 patients with parapneumonic empyema with multiloculation and septation in the pleural cavity treated with VATS or streptokinase in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, between January 2018 and January 2021. The main outcome measures of this study were hospital stay, febrile period, days with drainage, and treatment failure.ResultsA total of 46 patients were included in this study. Of these, 28 were treated with VATS deloculation, and 18 were treated with streptokinase. The average hospital stay was 2.8 ±1.7 days for the VATS group and 7.5 ±3.5 days for the streptokinase group (p < 0.001). The average days with fever were 1.9 ±0.7 days for the VATS group and 3.0 ±1.64 days for the streptokinase group (p = 0.017). The average days with drainage were 3.0 ±1.6 days for the VATS group and 7.5 ±4.4 days for the streptokinase group (p < 0.001). The success rate was 92.9% for the VATS group and 66.7% for the streptokinase group, which was significantly higher in the VATS group compared to the streptokinase group (p = 0.042). No cases of perioperative mortality occurred. The frequency of adverse events did not differ between study groups (p > 0.05).ConclusionsOur results demonstrated that treatment of empyema with VATS is superior to streptokinase therapy.

In-Hospital Outcome of Acute Myocardial Infarction in patients receiving Streptokinase

Objective: To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic (streptokinase) therapy versus those who were not thrombolysed. Methods: This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 1St of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase (SK) group and patients not receiving streptokinase (Non-SK) group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Results: Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58±11.02 years and Non-SK group was 55.78±10 years. In SK group 170(83.3%) patients were males and 34(16.7%) were females. Only 54(26.5%) diabetics and 150(73.5%) non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non-recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group p

Evaluation of ventricular tachyarrhythmias in patients with myocardial infarction after streptokinase therapy

Objectives: The occurrence of arrhythmias after myocardial infarction is associated with an increased risk of mortality. The purpose of this study was to investigate tachyarrhythmias after streptokinase therapy in myocardial infarction patients. Methods: This study was a case-control study. Among 262 patients with myocardial infarction who received streptokinase, 168 patients with ventricular tachyarrhythmia, ventricular fibrillation, or both (case group), and 94 patients without arrhythmia (control group) were selected. Their clinical information were collected by questionnaire. Data were analyzed using SPSS 20 software through chi-square test and Wilcoxon rank-sum. Results: There was no relationship between demographic variables or electrocardiogram changes and the type of arrhythmia in 168 participants in the group 1 (p &gt; 0.05). However, there was a significant relationship between age (p = 0.04), sex (p = 0.049), diabetes (p = 0.039), hypertension (p = 0.037), history of beta-blocker use (p = 0.028), history of aspirin use (p = 0.023), number of the leads involved (p = 0.023) and occurrence of arrhythmia among the participants in the group 2. Conclusions: According to the findings of this study, patients with myocardial infarction who need to receive thrombolysis and who have any of the following conditions should be monitored by the health care staff to prevent development of ventricular tachyarrhythmias: old age, male gender, history of diabetes mellitus, hypertension or more lead involvement in their electrocardiogram.

Correlation of Cardiac Troponin I with Left Ventricular Systolic Function in Patients with Acute ST-segment Elevated Myocardial Infarction

Myocardial infarction is one of the leading cause of death globally and following acute myocardial infarction prognosis depends on extent of myocardial damage. This study was aimed to correlate cardiac troponin I level with the left ventricular systolic function in patients with acute ST-elevated myocardial infarction. A total of 104 patients of acute ST-segment elevated myocardial infarction receiving streptokinase therapy within 12 hours of onset of chest pain were studied. Cardiac troponin I concentration was measured by immunometric assay and echocardiographic left ventricular ejection fraction was calculated by modified biplane Simpson's method. Left ventricular ejection fraction (LVEF) was compared with serum cardiac troponin I concentration. Study subjects were divided into two groups on the basis of LVEF. In group I, there were 54 patients with LVEF &lt; 50% and in group II, there were 50 patients with LVEF &gt;_ 50%. The mean cTnI within 12 hours of onset was 129 ± 8.7 ng/ml in group I and11 ± 2.1 ng/ml group II and the difference was statistically significant (p&lt;0.001). Serum cardiac troponin I concentration has a strong negative correlation with left ventricular ejection fraction after first acute myocardial infarction. A level of serum cardiac troponin I &gt;_ 6.6 ng/ml provided a good indication for LVEF &lt;50% and this can be used to detect patients with higher risk. Faridpur Med. Coll. J. 2021;16(1):34-38

Killip classification and baseline heart rate can be used to predict streptokinase‑induced hypotension in acute myocardial infarction

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.

A Comparative Study to Assess the Efficacy of Streptokinase in Diabetic Versus Non-Diabetic Acute ST Elevation Myocardial Infarction Patients

Objective: Prominent resolution in the ST segment elevation on electrocardiogram(ECG), thrombolysis at the infarction site restoring perfusion determines the effectiveness of the streptokinase therapy. Hyper- coagulable states and lack of efficacy with streptokinase is seen in diabetics. This study aimed to assess the thrombolytic efficacy of streptokinase in diabetic vs non-diabetics patients. Methods: A cross-sectional study was conducted at Cardiology Department of Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st September 2019 to 30th April, 2020. Total 504 patients of which 185 diabetics and 319 non-diabetic were selected. All the patients presenting with first episode of acute ST- elevation myocardial infarction were thrombolysed with 1.5million units of streptokinase within 12hours from the onset of their typical chest pain symptoms. A complete record of ECG changes was kept before and 90 min after thrombolysis with streptokinase. Chi- square test was applied and p value &lt;0.05 was considered significant. Results: 89.19% diabetic patients had &gt;70% resolution of ST segment changes in comparison to 95.61% non-diabetics. 16.76% of the diabetic patients had increased ST-segment elevation post thrombolysis (P- value 0.001). 8.11% and 10.81% reinfarction rates during hospital stay and at one month post-thrombolysis were recorded in diabetics. Reduced left ventricle Ejection Fraction was seen in 62.16% and 58.62% of the diabetic and non-diabetic patients(P-value&lt;0.005). Conclusion: Comparatively decreased efficacy of streptokinase is seen in diabetic patients with reduced resolution of ST-segment. In correspondence with reduced left ventricle EF, re-infarction and stroke episodes. Key Words: Streptokinase, acute myocardial infarction, STEMI, diabetes mellitus, hypercoagulability, atherosclerosis. How to Cite: Hassan Z., Rana N., Rana B., Iqbal I., Chughtai J.I. A comparative study to assess the efficacy of streptokinase in diabetic versus non-diabetic acute ST elevation myocardial infarction patients. Esculapio 2021;17(01):88-92

Abstract 262: Consumptive Coagulation in a Porcine Model of Prolonged Out-of-hospital Cardiac Arrest Treated with ECPR

Background: Following prolonged cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR), recovery of organ function and survival are potentially impaired due to a “no reflow” phenomenon associated with microvascular thrombosis. This study evaluated the effects of antithrombotic interventions on coagulation parameters in a in a porcine model of out-of-hospital cardiac arrest (OHCA). Hypothesis: We hypothesized that anticoagulant therapy (argatroban) during CPR and/or thrombolytic (streptokinase) therapy at onset of ECPR would prevent consumptive coagulopathy after prolonged cardiac arrest. Methods: In a blinded and randomized study, 48 swine (40±5kg) were subjected to 8min of ventricular fibrillation cardiac arrest followed by 30min of goal-directed CPR (gdCPR), and 8hr of ECPR (33°C) with heparin anticoagulation during ECPR titrated to ACT values (200-300s). Animals were randomized to one of 4 groups (n=12) with 350mg/kg argatroban (Arg) or placebo (20mL NSS) administered 12min after arrest and 1.5 MU streptokinase (STK) or placebo (50mL NSS) at ECPR initiation: Group 1 (placebo and placebo); Group 2 (Arg and placebo); Group 3 (placebo and STK); and Group 4 (Arg and STK). Blood samples were drawn at baseline and at 8hr of ECPR (or earlier if the experiment ended). Data was analyzed using t-tests and ANOVA (p&lt;0.05 significant). Results: Average platelet count and fibrinogen levels significantly decreased between baseline and at the end of ECPR ( p =&lt;0.0001) without difference between groups ( p =0.6315 and p =0.7692, respectively). D-dimer levels significantly increased across groups from baseline to the end of ECPR ( p =&lt;0.0001) without difference between groups ( p =0.1881). Discussion: These results indicate that this OHCA model induces consumptive coagulopathy and the effects of antithrombotic therapies did not mitigate it in this porcine model.

Role of streptokinase in management of retained hemothorax: a multicentric study

Background: Enzymatic debridement of the pleural cavity for retained haemothorax is a frequently overlooked option.Methods: A retrospective, multicentre study was carried out using intrapleural streptokinase was carried out in 15 patients with retained or clotted haemothorax.Results: Thirteen of fifteen patients (86%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase injections in our study. The average increase in chest tube output following streptokinase injections was 160%. No significant adverse reactions occurred. Two patients required thoracotomy when streptokinase therapy failed. No deaths were reported in the study.Conclusions: Intrapleural streptokinase is a safe, effective means of removing retained proteinaceous collections in the pleural space. It is a useful adjunct to chest tube drainage and may obviate the need for more invasive procedures.

Study of Adverse Events of Streptokinase Therapy in Patients with Acute ST Elevation Myocardial Infarction

Background: Despite of different adverse events, streptokinase (SK) is widely used to treat patients presented with acute ST segment elevation myocardial infarction. Objective: The purpose of the present study was to observe different adverse events in patients of acute ST segment elevation myocardial infarction receiving SK infusion. Methodology: This cross-sectional type of analytic observational study was carried out in the inpatient department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from December 23rd 2019 to February 22nd 2020 for a period of two (2) months. All patients diagnosed as acute ST segment elevation myocardial infarction receiving SK were included in the present study. Adverse events were documented through completing a questionnaire by reviewing the records in the medical file as well as interviewing with the patients. Result: In this study, 43 (26.2%) patients developed different types of adverse events and 121 (73.8%) had no complications following SK infusion. The most common adverse event was hypotension i.e. 26 (60.4%) and other adverse events were bleeding 8 (4.8%) and allergic reaction 7 (4.2%). Statistically significant higher rate of adverse events occurred in diabetic, hypertensive and dyslipidemia group which was 26 (56.5%) Vs. 17 (14.4%), p = 0.000, 37 (36.6%) Vs. 06 (09.5%), p = 0.000 and 18 (54.5%) Vs. 25 (19.1%), p = 0.000 respectively. The independent factors for the development of adverse events were smoking {OR: 5.1 with 95% CI (1.7 to 15.1), p = 0.003}, diabetes {OR: 14.9 with 95% CI (5.0 to 44.8), p = 0.000}, hypertension {OR: 5.1with 95% CI (1.7 to 15.1), p = 0.003} and dyslipidemia {OR: 4.6 with 95% CI (1.5 to 13.7), p = 0.007}. Conclusion: Streptokinase infusion was associated with different adverse events. Among them the commonest one was hypotension and other less common events were minor bleeding and minor allergic reaction. The adverse events were more frequently documented in patients who were smoker, diabetic, hypertensive and dyslipidemic.

Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate...

Clinical Impacts of ST- Segment Non-Resolution after Thrombolysis for Myocardial Infarction

Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as &lt;50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of &lt;0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients.&#x0D; University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7

Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital.

Background:Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain. Majority of chest pain victims attend the primary physician in golden hours. Hence, primary doctors can play important role for early thrombolysis and salvage the myocardium from irreversible injury. This study determined year mortality in a patient who received the rapid thrombolysis at primary care hospital (streptokinase or tenecteplase) at rural setting.Setting:Peripheral General Hospital Mahad on Mumbai–Goa highway.Patients and Methods:Patients with typical chest pain with electrocardiogram showed ST segment elevated myocardial infarction (STEMI) with or without risk factors admitted from 2005 to march 2016 were studied. Details clinically studied: time interval between chest pain to hospital, hospital to needle time, reperfusion and arrhythmias. Time required for regression of elevated ST segment, a response to thrombolytic (streptokinase or tenecteplase) therapy, is studied.Results:Total 244 patient reported with chest pain of these 35 cases brought dead with history of chest pain and convulsive moment before they died. Of these, 209 patients had acute STEMI. Of these, 162 received streptokinase (STK) and 47 received tenecteplase (TNP)]. Analysis of STK Vs TNP patients 18 (11.11%) versus 3 (6.38%) (P = 0.361) died during the treatment. Around 17 (18.49%) vs 5 (10.63%) (P = 0.941) did not show signs of reperfusion, respectively. Re infarction occurred during hospitalization 3 (2.5%) versus 3 (6.38%) (P = 0.094) cases. Around 12 (7.40%) versus 0% (P = 0.072) died at the end of 12 months of thrombolytic therapy.Conclusion:Thrombolysis of STEMI within golden hours improved the reperfusion. However, 1-year fatality is significance with streptokinase as compared with tenecteplase.

Clinical and laboratory efficiency of using anti-inflammatory and antithrombotic drugs for the treatment of acute salpingoophoritis

We studied clinical and laboratory efficacy of using comprehensive anti-inflammatory and antithrombotic agents for the treatment of 100 patients with acute salpingoophoritis.The criteria for attracting patients to the study were: age 18 to 45 years and diagnosis "acute salpingoophoritis" (pain radiating to the lower extremities and groin, at least in the lower back and rectum, symptoms of intoxication (fever, tachycardia), increased secretory function). The nearest and remote results of treatment (in 14 days and after 6–9 months after initiation of therapy) pointed to the high efficiency of the proposed complex anti-inflammatory therapy involving complex antibacterial drug (antibacterial and antiprotozoal orientation) in combination with a local anti-inflammatory, anti-thrombotic, proteolytic (rectal suppositories with streptokinase and streptodornase) therapy of acute salpingoophoritis. Taking the used effectiveness criteria (data of pain, data of general and gynecological examination, hemogram data, smear microscopy of the cervix and vagina, pelvic ultrasound, complications, duration of treatment, side effects of therapy) treatment efficiency of patients was 96 %.High efficiency of treatment is not accompanied by side effects and is well tolerated by patients.

Clinical and laboratory efficiency of using anti-inflammatory and antithrombotic drugs for the treatment of acute salpingoophoritis

We studied clinical and laboratory efficacy of using comprehensive anti-inflammatory and antithrombotic agents for the treatment of 100 patients with acute salpingoophoritis.The criteria for attracting patients to the study were: age 18 to 45 years and diagnosis "acute salpingoophoritis" (pain radiating to the lower extremities and groin, at least in the lower back and rectum, symptoms of intoxication (fever, tachycardia), increased secretory function). The nearest and remote results of treatment (in 14 days and after 6–9 months after initiation of therapy) pointed to the high efficiency of the proposed complex anti-inflammatory therapy involving complex antibacterial drug (antibacterial and antiprotozoal orientation) in combination with a local anti-inflammatory, anti-thrombotic, proteolytic (rectal suppositories with streptokinase and streptodornase) therapy of acute salpingoophoritis. Taking the used effectiveness criteria (data of pain, data of general and gynecological examination, hemogram data, smear microscopy of the cervix and vagina, pelvic ultrasound, complications, duration of treatment, side effects of therapy) treatment efficiency of patients was 96 %.High efficiency of treatment is not accompanied by side effects and is well tolerated by patients.

On-shelf Streptokinse EnsuRes More Favorable In-hospital Outcome after Acute STEMI (OSTRIC trial) - A Single Centre Randomized Controlled Trial

Introduction: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion.&#x0D; Methods: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay.&#x0D; Results: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=&lt;0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=&lt;0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy.&#x0D; Conclusion: Despite the strength of evidence based medicine pertaining to the benefits of primary PCI in STEMI, treatment options in Bangladesh are often dictated by resources, logistics, availability and affordability. In our country, not many hospitals offer primary PCI services round the clock. So thrombolysis by streptokinase it the potential reperfusion strategy in our context. In our study it has been found that onshelf Streptokinase significantly reduce door to injection time which ultimately reduce cardiovascular mortality and mortality and also significantly reduce hospital stay. Hospitals intended to treat acute STEMI patients should have on-shelve Streptokinase to reduce door to injection time which affect the inhospital outcome by reducing significant cardiovascular mortality and morbidity.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 126-133