Streptokinase is the least expensive fibrinolytic agent, but unfortunately it is highly antigenic and produces a high incidence of untoward reactions. This drawback limits the usefulness of streptokinase in the clinical setting.
Streptokinase is produced by beta-hemolytic streptococci. It was first isolated in 1933 and entered clinical use in the mid-1940s. Streptokinase by itself is not a plasminogen activator, but it binds with free circulating plasminogen (or with plasmin) to form a complex that can convert additional plasminogen to plasmin. Streptokinase activity is not enhanced in the presence of fibrin.
The principal plasma activity half-life of streptokinase is about 20 minutes, but an unbound fraction (about 15%) has a half-life of 80 minutes. Since it is produced from streptococcal bacteria, it often causes febrile reactions and other allergic problems. Streptokinase usually cannot be administered safely a second time within 6 months, because it is highly antigenic and results in high levels of antistreptococcal antibodies.
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