One of eight smaller studies using a similar dosing schedule showed a statistically significant reduction in mortality. When all of these studies were pooled, the overall decrease in mortality was approximately 23%. Results from pooling several studies using different dosages with long term infusion corroborate these observations.

In addition, studies measuring left ventricular ejection fraction (LVEF) at discharge showed the mean LVEFs were 3-6 percentage points higher in the Streptokinase group than in the control group. This difference was statistically significant in some of the studies ^(3,4) . Furthermore, some studies reported greater improvement in LVEF among patients treated within three hours than in patients treated later.

Results from a randomized controlled trial in over 11,000 patients show that, following treatment with IV Streptokinase, there is a reduction in the number of patients with clinical congestive heart failure during the 14-21 day in-hospital period. Clinical congestive heart failure occurred in 12.8% of Streptokinase-treated patients compared with 15% of the control patients (p=0.001) ⁽¹⁾ .

The rate of reocclusion of the infarct-related vessel has been reported to be approximately 15-20%. The rate of reocclusion depends on dosage, additional anticoagulant therapy and residual stenosis. When the reinfarctions were evaluated in studies involving 8800 Streptokinase-treated patients, the overall rate was 3.8% (range 2-15%). In over 8500 control patients, the rate of reinfarction was 2.4%. However, the ISIS-2 study showed that an increase in reinfarction was avoided when Streptokinase was combined with low dose aspirin. The rate of reinfarction in the combination group was 1.8% vs. 1.9% in the group given aspirin alone.

Streptase, Streptokinase, administered by the intracoronary route has resulted in thrombolysis usually within one hour, and ensuing reperfusion results in improvement of cardiac function and reduction of mortality ^(5,6) . LVEF was increased in patients treated with Streptokinase when compared to patients treated with conventional therapy. When the initial LVEF was low, the Streptokinase-treated patients showed greater improvement than did the controls. Spontaneous reperfusion is known to occur and has been observed with angiography at various time points after infarction. Data from one study show that 73% of Streptokinase-treated patients and 47% of the placebo-allocated patients reperfused during hospitalization. The relationship between coronary artery patency and clinical efficacy has not been established.

Studies with thrombolytic therapy for pulmonary embolism show no significant difference in lung perfusion scan between the thrombolysis group and the heparin group at one-year follow-up. However, measurements of pulmonary capillary blood volumes and diffusing capacities at two weeks and one year after therapy indicate that a more complete resolution of thrombotic obstruction and normalization of pulmonary physiology was achieved with thrombolytic therapy, thus preventing the long term sequelae of pulmonary hypertension and pulmonary failure ⁽⁷⁾ .

The long term benefit of Streptase, Streptokinase, therapy for deep vein thrombosis (DVT) has been evaluated venographically ⁽⁸⁾ . The combined results of five randomized studies show no residual thrombotic material in 60-75% of patients treated with Streptokinase versus only 10% of those treated with heparin. Thrombolytic therapy also preserves venous valve function in a majority of cases, thus avoiding the pathologic venous changes that produce the clinical post-phlebitic syndrome which occurs in 90% of the DVT patients treated with heparin.

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