Streptokinase

INTRODUCTION

Indications

Acute myocardial infarction (MI). Pulmonary embolism (PE). Deep vein thrombosis (DVT). Acute peripheral arterial thrombosis. Occluded arteriovenous cannulae.

Action

Combines with plasminogen to form activator complexes, then converts plasminogen to plasmin, which is then able to degrade clot-bound fibrin. Therapeutic Effects: Lysis of thrombi in coronary arteries, with preservation of ventricular function. Lysis of pulmonary emboli and subsequent restoration of blood flow. Restoration of cannula patency and function.

Adverse Reactions/Side Effects

CNS: INTRACRANIAL HEMORRHAGE. EENT: epistaxis, gingival bleeding. Resp: bronchospasm, hemoptysis. CV: reperfusion arrhythmias, hypotension, RECURRENT ISCHEMIA/THROMBOEMBOLISM. GI: GI BLEEDING, hepatotoxicity, nausea, RETROPERITONEAL BLEEDING, vomiting. GU: GU TRACT BLEEDING. Derm: ecchymoses, flushing, urticaria. Hemat: BLEEDING. Local: hemorrhage at injection site, phlebitis at injection site. MS: musculoskeletal pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, coughing up blood, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Be especially alert for signs of intracranial bleeds, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances. Notify physician or nursing staff immediately if these signs occur.

• Be alert for signs of recurrent cardiac ischemia (chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety) or recurrent peripheral arterial thrombosis (pain, cramping, coldness, cyanosis in the affected limb). Notify physician or nursing staff immediately if these signs occur.

• Monitor signs of recurrent thromboembolism and PE such as shortness of breath, chest pain, cough, and bloody sputum. Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if PE is suspected.

• Watch for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds when cardiac perfusion is restored (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure, especially for the first few days after infusion. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Assess any muscle of joint pain to rule out musculoskeletal pathology or hemorrhage; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems. Be especially concerned about back pain that could indicate retroperitoneal bleeding.

• Watch for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs ...