Whether failure to timely recanalize coronary artery with intravenous streptokinase (SK) is related to inadequate fibrinolysis remains controversial. Since coagulation might also interfere with the course of clot lysis, this relation was investigated in 27 patients (pts) pretreated with heparin (10.000 IU bolus). 500.000 to 1.500.000 IU SK were infused in 45 min, 160 ± 60 min after the onset of infarct.Angiographic control, performed 219 ± 199 min after SK, showed persistent coronary occlusion in 5 pts (0CC) and patency in 22 (PAT), unrelated to SK dosage. One to 3 hours post SK, fibrinogen (Fg) (Clauss Method) was undetectable in all 22 PAT and 4/5 0CC. However, Fg (and clottable breakdown products) assessed by Gram's method* was detected in all 5 OCC and 3/22 PAT (164 ± 89 VS 13 ± 38 mg %, p < 0.005). Prolongation of thrombin time (neutralized with protamine) was limited in OCC, compared to PAT (59 ± 6 VS 96 ± 11 sec, p < 0.005), supporting the hypothesis of the presence of clottable material in OCC. These results were accompanied by slight differences of ELT (< 20 min in 2/5 OCC VS 21/22 PAT) and non significant differences in plasminogen (1.78 ± 1 VS 2.18 ± 1.1 mg/dl ; NS), α2 antiplasmin (1.7 ± 1.7 VS 3.9 ± 6.9 % ; NS), plasmin (12 ± 4 VS 16 ± 11 mm2 ; NS) and plasminogen activators (95 ± 41 VS 105 ± 23 mm2 ; NS).Conclusion : at similar systemic lytic activity induced by SK, failure of arterial recanalization was associated wih an apparent incomplete fibrinogenolysis (and fibrinolysis) in 20 % of the patients.*Gram H.C. - A new method of determination of the fibrin percent in blood and plasma - J Biol Chem 49 : 279 - 295 (1921)mean ± SD
Survey side effect of intravenous Streptokinase in old patients with acute myocardial infarction.
