Streptokinase vs. TPA

Attribute	Streptokinase	TPA
Drug Type	Enzyme	Enzyme
Source	Bacterial	Recombinant DNA technology
Indication	Acute myocardial infarction, deep vein thrombosis, pulmonary embolism	Acute ischemic stroke, acute myocardial infarction, pulmonary embolism
Mechanism of Action	Converts plasminogen to plasmin, which breaks down fibrin clots	Activates plasminogen to plasmin, which breaks down fibrin clots
Administration	IV infusion	IV infusion
Half-life	20-30 minutes	4-6 minutes
Side Effects	Bleeding, allergic reactions	Bleeding, allergic reactions
Contraindications	Active bleeding, recent surgery, history of stroke	Active bleeding, recent surgery, history of stroke

Introduction

Streptokinase and TPA (tissue plasminogen activator) are both thrombolytic agents used in the treatment of various medical conditions related to blood clotting. While they share the common goal of dissolving blood clots, these drugs differ in their mechanisms of action, administration, indications, and potential side effects. Understanding the attributes of each medication is crucial for healthcare professionals to make informed decisions regarding their use. In this article, we will explore and compare the attributes of Streptokinase and TPA.

Mechanism of Action

Streptokinase is a non-enzymatic protein derived from streptococcal bacteria. It works by activating plasminogen, a precursor to plasmin, which is an enzyme responsible for breaking down fibrin clots. Once activated, plasmin degrades fibrin, leading to clot dissolution. On the other hand, TPA is a naturally occurring enzyme in the body that specifically activates plasminogen bound to fibrin within the clot. This targeted action of TPA makes it more fibrin-specific and potentially more effective in dissolving clots.

Administration

Streptokinase is administered intravenously, typically as a continuous infusion over several hours. The dosage and duration of treatment depend on the specific condition being treated. In contrast, TPA can be administered intravenously or directly into the affected blood vessel. The dosage and administration regimen for TPA also vary depending on the indication, such as acute ischemic stroke or myocardial infarction. The ability to administer TPA directly into the clot site allows for more targeted therapy in certain cases.

Indications

Streptokinase is primarily used in the treatment of acute myocardial infarction (heart attack), deep vein thrombosis, and pulmonary embolism. It is also occasionally used in arterial occlusions. TPA, on the other hand, has a broader range of indications. It is commonly used in acute ischemic stroke, acute myocardial infarction, and pulmonary embolism. Additionally, TPA can be used in the management of occluded central venous catheters and arterial thrombosis associated with certain medical procedures.

Side Effects

Both Streptokinase and TPA carry the risk of bleeding complications, which is the most significant side effect associated with thrombolytic therapy. However, the risk of bleeding may be higher with Streptokinase due to its non-specific action on plasminogen activation. Other potential side effects of Streptokinase include allergic reactions, fever, and hypotension. TPA, being more fibrin-specific, may have a lower risk of bleeding complications. However, it can still cause bleeding, especially if administered at higher doses or in patients with an increased risk of bleeding.

Contraindications

There are certain contraindications for the use of both Streptokinase and TPA. Streptokinase should not be used in patients with a history of recent bleeding, active internal bleeding, or known hypersensitivity to the medication. TPA should be avoided in patients with a history of recent stroke, intracranial bleeding, or known hypersensitivity to the drug. Additionally, TPA should be used with caution in patients with uncontrolled hypertension, recent surgery, or trauma.

Comparative Efficacy

When comparing the efficacy of Streptokinase and TPA, it is important to consider the specific indication being treated. In general, TPA is considered more effective in the treatment of acute ischemic stroke and acute myocardial infarction. Studies have shown that TPA administration within a specific time window after symptom onset can significantly improve patient outcomes. Streptokinase, while less fibrin-specific, has demonstrated efficacy in the treatment of deep vein thrombosis and pulmonary embolism. The choice between these medications depends on the specific clinical scenario and the potential risks and benefits for each patient.

Conclusion

In conclusion, Streptokinase and TPA are both thrombolytic agents used in the treatment of various conditions related to blood clotting. While Streptokinase is a non-enzymatic protein that activates plasminogen, TPA is a naturally occurring enzyme that specifically activates plasminogen bound to fibrin. The administration, indications, and potential side effects of these medications differ, with TPA having a more targeted approach and broader range of indications. Both drugs carry the risk of bleeding complications, but the risk may be higher with Streptokinase due to its non-specific action. Understanding the attributes of Streptokinase and TPA is essential for healthcare professionals to make informed decisions regarding their use and provide optimal care to patients.