Evaluation of ventricular tachyarrhythmias in patients with myocardial infarction after streptokinase therapy

Objectives: The occurrence of arrhythmias after myocardial infarction is associated with an increased risk of mortality. The purpose of this study was to investigate tachyarrhythmias after streptokinase therapy in myocardial infarction patients. Methods: This study was a case-control study. Among 262 patients with myocardial infarction who received streptokinase, 168 patients with ventricular tachyarrhythmia, ventricular fibrillation, or both (case group), and 94 patients without arrhythmia (control group) were selected. Their clinical information were collected by questionnaire. Data were analyzed using SPSS 20 software through chi-square test and Wilcoxon rank-sum. Results: There was no relationship between demographic variables or electrocardiogram changes and the type of arrhythmia in 168 participants in the group 1 (p > 0.05). However, there was a significant relationship between age (p = 0.04), sex (p = 0.049), diabetes (p = 0.039), hypertension (p = 0.037), history of beta-blocker use (p = 0.028), history of aspirin use (p = 0.023), number of the leads involved (p = 0.023) and occurrence of arrhythmia among the participants in the group 2. Conclusions: According to the findings of this study, patients with myocardial infarction who need to receive thrombolysis and who have any of the following conditions should be monitored by the health care staff to prevent development of ventricular tachyarrhythmias: old age, male gender, history of diabetes mellitus, hypertension or more lead involvement in their electrocardiogram.

Role of streptokinase in management of retained hemothorax: a multicentric study

Background: Enzymatic debridement of the pleural cavity for retained haemothorax is a frequently overlooked option.Methods: A retrospective, multicentre study was carried out using intrapleural streptokinase was carried out in 15 patients with retained or clotted haemothorax.Results: Thirteen of fifteen patients (86%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase injections in our study. The average increase in chest tube output following streptokinase injections was 160%. No significant adverse reactions occurred. Two patients required thoracotomy when streptokinase therapy failed. No deaths were reported in the study.Conclusions: Intrapleural streptokinase is a safe, effective means of removing retained proteinaceous collections in the pleural space. It is a useful adjunct to chest tube drainage and may obviate the need for more invasive procedures.

Clinical Impacts of ST- Segment Non-Resolution after Thrombolysis for Myocardial Infarction

Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of <0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients. University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7

Angiographic patency of streptokinase in STEMI patients: smokers vs. non-smokers

Background: Acute coronary syndrome is one of the leading causes of death. Smoking is known to be associated with many influencing factors for accelerating Myocardial Infarction (MI). In a country like India, Streptokinase (SK) is used as a leading therapeutic option for the treatment of ST elevation myocardial Infarction (STEMI). SK combines with plasminogen; this SK-plasminogen complex is responsible for fibrinolysis. The aim of this study was to determine angiographic patency after SK infusion in STEMI patients and comparison between smokers and non-smokers.Methods: In this observational, prospective and single-centre study conducted between September 2011 and April 2012, a total of 398 patients who were diagnosed with STEMI were included. Patients were divided in two groups i.e. smokers and non-smokers. The patients were treated with thrombolytic (streptokinase) therapy and evaluated for TIMI 3 flow by performing angiography within 72hours of thrombolysis with SK.Results: Of total 398 patients, 348 (87.4%) were male. The ratio of non-smokers and smokers was 1:2. Smokers were younger than the non-smokers (48.8±10.2 vs. 54.57±9.51). Post thrombolytic therapy, patients were evaluated for TIMI flow grades. Total of 202 patients achieved TIMI 3 flow, of which 157 were smokers and 45 were non-smokers.Conclusions: Smokers have relatively hypercoagulable state than non-smokers. Better outcome in smokers group may be because of younger age and lesser comorbidities. Smokers should be motivated and guided properly to quit smoking.

Lingual and Sublingual Haematoma in a Patient Following Streptokinase Administration in Acute Myocardial Infarction- A Case Report

The value of thrombolysis by Streptokinase administration in the treatment of acute myocardial infarction is well established. Haemorrhage is a common complication of fibrinolytic therapy. Here, we report an unusual case of spontaneous lingual and sublingual haematoma following streptokinase therapy after acute myocardial infarction. A 57-year-old man with a diagnosis of acute ST elevated myocardial infarction treated with streptokinase developed a large lingual and sublingual haematoma. Though his airway was not compromised, he had difficulty in swallowing. A conservative approach was made by starting parenteral nutrition, preventing rethrombosis by not reversing the action of streptokinase as his coagulation profile was within normal limits and maintaining optimum blood pressure, blood glucose level and urine output. His tongue swelling subsided after four days and oral medication and feeding was started. No complication occurred during this period. Though there is no adequate information regarding the management of the patient, a vigilant monitoring of the patency of the airway with a conservative approach by not reversing the effect of streptokinase and preventing coronary rethrombosis may produce a better outcome in such cases.Cardiovasc. j. 2017; 10(1): 97-100