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Comparison of streptokinase and alteplase

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

streptokinase

Alteplase (t-PA)

molecular weight (daltons)

47K

70K

fibrin specificity

minimal

moderate

plasminogen binding

indirect

direct

potential allergic reaction

yes

no

plasma clearance (mins)

15-25

4-8

relative cost

+

+++

A meta-analysis of eight comparisons of standard alteplase with streptokinase found no significant difference between the two drugs in terms of mortality up to 35 days (odds ratio 1.0; 95% CI 0.94 to 1.06). A statistically significant difference in reinfarction rates in favour of alteplase was found (odds ratio 0.86; 95% CI 0.77 to 0.95). However, alteplase was associated with a statistically significant higher risk of stroke (odds ratio 1.37; 95% CI 1.16 to 1.62), due to a doubling in the risk of haemorrhagic stroke (odds ratio 2.13; 95% CI 1.04 to 4.36). However, streptokinase was associated with a statistically significant higher risk of major bleeds (other than stroke) than alteplase (odds ratio 0.81; 95% CI 0.68 to 0.97). The categorisation and reporting of major bleeding varied between the trials and so it is difficult to judge the clinical significance of these findings.

Reference:

  1. NICE (October 2002). Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction.

 


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