The hypotensive effect of intravenous streptokinase in patients with acute myocardial infarction.

Abstract

We studied the hypotensive effect of a rapid intravenous infusion of high-dose streptokinase in 98 patients with an acute myocardial infarction. The systolic blood pressure fell from 132 + 20 (range 90 to 174) to 97 21 mm Hg (range 58 to 152) at 15 8 min (range 4 to 40) after the commencement of the streptokinase infusion (p < .00 1). A fall in diastolic blood pressure from 80 + 16 (range 51 to 105) to 61 15 mm Hg (range 32 to 92) accompanied the fall in systolic pressure (p < .001). The fall in blood pressure was associated with an increase in heart rate (73 14 to 78 + 17 beats/min, p < .001), preceded the appearance of clinical signs of reperfusion by 37 38 min and was similar in magnitude and timing in patients with anterior and inferior infarction. There were direct relationships between the rate of infusion of streptokinase and both the magnitude (r = .49, p < .001) and the rate of fall of systolic blood pressure (r = .67, p < .001) as well as both the magnitude and rate of fall of diastolic blood pressure. In most patients, the fall in blood pressure was transient (9 + 6 min, range = 2 to 30) and easily managed by slowing or stopping the infusion, placing the patient in the Trendelenburg position, or by administering an infusion of low-dose norepinephrine or dopamine. However, in four patients with severe left ventricular dysfunction, severe hypotension persisted for more than 60 min. Our data indicate that in patients with either anterior or inferior myocardial infarction, a rapid infusion of high-dose intravenous streptokinase may frequently cause transient and sometimes severe hypotension, the magnitude of which is directly related to the rate of infusion of streptokinase. Circulation 72, No. 6, 1321No. 6, -1326No. 6, , 1985 SHORT-TERM INTRAVENOUS INFUSION of high-dose streptokinase is an effective method of coronary thrombolysis and coronary artery reperfusion during an acute myocardial infarction.1-9 In most recent studies, intravenous streptokinase has been administered rapidly so as to achieve a high concentration of streptokinase in proximity to the coronary thrombus and thereby accelerate thrombolysis.'0-'3 One limitation of the administration of a rapid intravenous infusion of streptokinase is that it can cause a significant fall in systemic blood pressure.4' 5' This study investigates the frequency and severity of the hypotensive effect of intravenous infusion of streptokinase in patients with acute myocardial infarction and its relationship to the rate of the infusion. MethodsPatient population. The patient population consisted of 101 consecutive patients who were entered into a prospective study of intravenous streptokinase in acute myocardial infarction and in whom ie systemic blood pressure was continuously monitored duri the infusion of streptokinase. The study inclusion criteria were (1) chest pain of 3 hr or less duration, (2) ST segment elevation indicative of transmural ischemia, (3) unresponsiveness of both the chest pain and the electrocardiographic changes to sublingual n...

Mast cell activation by fibrinogen-related homologous c-terminal peptides (haptides) modulates systemic blood pressure

“…Streptokinase-based treatment was found to be associated with a risk of developing hypotension. 12,45 The mechanism responsible for this streptokinase effect remains unknown. 18,46,47 We suggest that streptokinase-induced fibrinolysis through plasmin activation results in the release of smaller fragments containing the C-termini of fibrin with haptide sequences, 8,9 which, as shown here, may trigger hypotension.…”

Platelet-activating factor antagonism and streptokinase-induced hypotension in clinical acute myocardial infarction

“…The time of 30 min for the administration of 1.5i10' units of SK, and the criteria for slowing administration, were chosen in the study because, from our experience and that of others [4][5][6]19], substantial hypotension was likely to result. We anticipated that this would allow the efficacy of lexipafant to be assessed by determining the hypotension induced by SK, the number of subjects in whom slowing of the administration was required, and the time over which it was possible to give SK.…”

“…For example, in one study, when 750 000 units of SK was given to 98 patients with AMI over 30p16 min (meanpS.D. ), systolic blood pressure (SBP) fell by 35p19 mmHg [4]. Most early experience with SK administration was consistent with such results, leading to the prevailing regimen.…”

“…It could be advantageous to be able to administer SK by an accelerated regime. SK is commonly given over 1 h, in a dose of 1.5i10' units, and the major impediment to its more rapid administration is hypotension, with the magnitude of the blood pressure fall varying directly with the rate of SK administration [4]. Significant hypotension frequently ensues if an attempt is made to administer 1.5i10' units over 30 min.…”

Thrombolytic therapy for acute myocardial infarction

“…Allergic reaction (rash, chills, urticaria) occurs in ϳ 4% of patients and anaphylactic shock occurs in 0.5% of patients [1]. Hypotension can be significant (average decrease ϳ 35 mm systolic blood pressure (SBP) [2] and may be worsened by rapid administration, which excludes bolus use and necessitates constant IV infusion. It is most commonly given as 1.5 million units over 60 min.…”