THROMBOLYSIS IN THE TREATMENT OF ACUTE STROKE: IS THERE A ROLE FOR STREPTOKINASE WHEN TISSUE PLASMINOGEN ACTIVATOR IS NOT AVAILABLE? | [Journal of Postgraduate Medical Institute • 2013]

Author(s):

1. Ashfaq Shuaib: Division of Neurology, University of Alberta, Edmonton, Alberta, Canada

2. Askar Mohammad: Division of Neurology, University of Alberta, Edmonton, Alberta - Canada

3. Akhtar Sherin: Department of Medicine, Khyber Medical University(KMU) Institute of Medical Sciences, Kohat, Pakistan

4. Ken Butcher: Division of Neurology, University of Alberta, Edmonton, Alberta, Canada

5. Khurshid Khan: Division of Neurology, University of Alberta, Edmonton, Alberta, Canada

6. Muhammad Tariq: Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

7. Umar Shuaib: Shifa Medical College Islamabad, Pakistan

8. Hiba Khan: Shifa Medical College Islamabad, Pakistan

9. Adnan Khan: Department of Neurology, Lady Reading Hospital, Peshawar, Pakistan

Abstract:

Every year 350,000 people suffer an acute stroke in Pakistan. Treatment of acute stroke has not improved significantly despite the availability of intravenous thrombolysis with tissue plasminogen activator (tPA). The drug is expensive and is offered to a selected few. Streptokinase (SK), a low cost alternative thrombolytic agent, is widely available in Pakistan and is utilized to treat patients with acute coronary syndromes. Streptokinase was tested in acute stroke in the 1980's and found to be ineffective in ischemic stroke. This is likely due to trial design flaws, rather than the drug itself. Factors that may have contributed to poor outcomes include a prolonged treatment window, inclusion of patients with established infarction on CT scan, failure to treat excessive arterial pressures, a fixed dose of streptokinase and concomitant use of antithrombotic medications. Given the lack of therapeutic alternatives we believe that a properly designed trial in appropriate patient population utilizing stricter inclusion criteria, including early treatment with a lower dose of SK is warranted.

Page(s): 122-128

DOI: DOI not available

Published: Journal: Journal of Postgraduate Medical Institute, Volume: 27, Issue: 2, Year: 2013

Keywords:

Stroke , thrombolysis , Streptokinase

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