Research Article
Volume 5 Issue 1 - 2021
Can the Adjunctive Therapy Increase the Efficacy of Streptokinase in ST Elevation Myocardial Infarction?
Souissi Sami*, Ben Turkia Hela, Ghazali Hanene, Chermiti Ines, Zaouche Khadija and Keskes Syrine
Emergency Department, Regional Hospital of Ben Arous, Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
*Corresponding Author: Souissi Sami, Emergency Department, Regional Hospital of Ben Arous, Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia.
Received: November 18, 2020; Published: December 10, 2020


Introduction: In ST segment elevation acute myocardial infarction (STEMI), pharmaco-invasive therapy with thrombolytic regimens is the cornerstone of achieving reperfusion, when primary PCI can’t be performed timely.

The combination of thrombolysis with modern adjunctive antithrombotic therapy (dual antiplatelets therapy and low molecular weight heparin) has been widely examined in large clinical studies with fibrin specific fibrinolytics. But its effects when streptokinase is used are not sufficiently known.

Can the modern antithrombotic adjunctive therapy increase the efficacy of streptokinase?

Aim of the Study: The aim of this study was to evaluate the efficiency and the safety of the use of the modern adjunctive therapy in patients treated with Streptokinase for STEMI.

Methods: A retroprospective analysis of prospective registry included patients with ST segment elevation acute myocardial infarction who were treated with Streptokinase. Two groups were distinguished: The examined group (EG) included patients treated with modern adjunctive antithrombotic therapy enrolled from January 2009 to March 2012 and the control group (CG) included patients treated with conventional adjunctive (aspirin and unfractionated heparin) therapy enrolled from February to December 2008. Comparative study between the two groups according to the coronary reperfusion defined by clinical criteria’s and bleeding risk.

Results: Inclusion of 271 patients. Mean age = 58 ± 11 years old, 85% were male. Forty-six patients were included in the control group, 225 patients in the examined group. Mean age and sex-Ratio were comparable in the two groups with respectively 57 ± 11 versus (vs) 58 ± 12 years (p = 0.36) and 4.1 versus 6.1(p = 0.45). The comparative study of cardiovascular risk factors between the first versus the second group (%): Current smoking (72) vs (77) (p = 0.45); Diabetes (39) vs (26) (p = 0.07); Hypertension (35) vs (28) (p = 0.36); dyslipidemia (17) vs (11) (p = 0.21). The mean delay onset of chest pain- first medical contact was about 3 hours in the two groups. There is no significative difference between the two groups according the early complications (N): Cardiogenic shock (1) in the first group vs (14) (p = 0.14); acute heart failure (9) vs (22) (p = 0.15); hematemesis (1) vs (6) (p = 0.8); intracranial bleeding (0) vs (2) (p = 0.75).

Thrombolysis success was higher in the examined group 63.3% versus 41.3% in the control group (p = 0.001).

Conclusion: In the STEMI patients; the modern adjunctive antithrombotic therapy can improve the efficacy of pharmacological reperfusion with streptokinase without enhancing bleeding risk.

Keywords: Myocardial Infarction; Streptokinase; Fibrinolysis Failure; Bleeding; Adjunctive Therapy


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Citation: Souissi Sami., et al. “Can the Adjunctive Therapy Increase the Efficacy of Streptokinase in ST Elevation Myocardial Infarction?”. EC Emergency Medicine and Critical Care 5.1 (2021): 14-19.

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