Pathophysiology of streptokinase-induced hypotension in acute myocardial infarction: a systematic review of clinical evidence

Abstract

Introduction: Despite the common occurrence of streptokinase-induced hypotension among patients with acute myocardial infarction, the underlying pathophysiology remains obscure and poorly understood. Our study aimed to pool clinical evidence on the potential mechanism of streptokinase-induced hypotension through a systematic review of the literature. Material and methods: We conducted literature search from Medline, Scopus and Web of Science on clinical studies related to streptokinase-induced hypotension. Results: Our search yielded 972 citations. After removal of duplicates, 878 articles were screened for eligibility, of which 856 papers were excluded due to various reasons. Of the remaining 22 articles retrieved with full texts, eight relevant articles were selected for final analysis. Three themes emerged as the proposed mechanisms of streptokinase-induced hypotension, including (i) reduction in total peripheral resistance, (ii) complement activation, and (iii) dismissal of hypotheses involving other intermediaries. Conclusions: Our findings suggest that the underlying mechanism of streptokinase-induced hypotension lies primarily in the reduction in total peripheral resistance.

Streptokinase and premedication strategies: Incidence of type I hypersensitivity reactions associated with streptokinase in clinical practice

“…Although the populations in those previous studies did not receive any premedication, the incidence and proportion of SK-induced hypotension were high. Consequently, the premedication regimen may not prevent hypotension owing to several mechanisms of SK-induced hypotension besides type I hypersensitivity mediated by IgE antibodies e.g., reduction in total peripheral resistance caused by the interplay of a reduction in whole blood viscosity and widespread vasodilatation (Khalid et al, 2021). Corticosteroids and antihistamines inhibit the immunological mechanism only.…”