Abstract

A CASE REPORT ON STREPTOKINASE-INDUCED INTRACRANIAL HEMORRHAGE (ICH)

Anoop David* and Jini Mariam Saji

ABSTRACT

Fibrinolytics are the preferred agents for the management of ST-elevation Myocardial Infarction (STEMI). The commonly used s fibrinolytic agents are Alteplase, Tenecteplase, Reteplase, and Streptokinase. Streptokinase (STK) is highly effective in breaking fibrin clots and restoring blood flow to the ischemic tissues. It is usually used as a short-term infusion. STK is extracted from beta-hemolytic streptococci of Lancefield group C bacteria. STK combines with plasminogen to form a complex, later it is converted to proteolytic enzyme plasmin. This formation of plasmin results in a series of reactions that ultimately leads to the lysis of fibrin clots. Here a 69- year-old female patient with ST-elevation myocardial infarction was treated with injectable Enoxaparin (30mg) and injectable Streptokinase as an intravenous infusion (1.5 million IU in 50ml normal saline over one hour). After eight hours of drug administration, the patient started vomiting and becoming disoriented. Her pulse rate was 80/min and her BP was 160/90mmHg. Following this CT brain was taken which showed a left frontal bleed. This incident was suspected to have occurred in association with streptokinase as bleeding is a common adverse event related to STK. STK-induced intracranial hemorrhage (ICH) is a rare, most destructive adverse effect and can cause death or severe morbidity to those exposed to the drug. This complication, which usually develops within the first few hours of treatment, cannot be predicted from routine tests of blood coagulability, and it occurs in the absence of any known contraindications to fibrinolytic therapy. So close monitoring is required for patients administering streptokinase.

Keywords: Myocardial Infarction, Fibrinolysis, Streptokinase, Left-frontal bleed, Streptokinase-induced intracranial hemorrhage.