Reply To: STABILITY OF STREPTOKINASE INJ

[Rani Sudarshana]

Dear Nawal,

– Generally speaking, initial treatment of intrinsic catheter-related thrombosis can be attempted within the hemodialysis facility and consists of first a forceful saline flush (risk of catheter rupture), and if not successful, intraluminal lytic enzyme instillation. If these 2 approaches didn’t work, then the catheter needs to be replaced.

– I think using 3 ml and wasting 97 ml (72750 IU) is not a cost-effective option, taking into consideration the high cost of Streptokinase that can be saved for other indications.

– Most of the available evidence recommended using catheter instillation with Alteplase 1-2 mg, which is available in appropriate strength to prevent unnecessary waste.

– In the past, urokinase was used as the agent of choice for this purpose and was reasonably effective. However, tissue plasminogen activator (tPA) has replaced urokinase for this purpose and has been shown to be significantly more effective 1,2,3.

– we are using intra-catheter Alteplase (Cathflo) 1-2 mg for catheter occlusion which seems safe, effective and cost-effective option.

– Check the attached file for dilution & stability information of the Streptokinase.

References:
1- Eyrich H, et al. Alteplase versus urokinase in restoring blood flow in hemodialysis-catheter thrombosis. J Health Syst Pharm. 2002;59(15):1437.
2- Haire WD, et al.Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. 1994;72(4):543.
3- Zacharias JM, et al. Alteplase versus urokinase for occluded hemodialysis catheters. Ann Pharmacother. 2003;37(1):27.