Once is enough

Thrombolysis is established treatment in the early management of myocardial infarction, and it reduces 35 day mortality by about a quarter.1 The GUSTO study has suggested some advantage of alteplase (rt-PA) over streptokinase with regard to early patency of the occluded coronary artery.2 In particular, GUSTO has suggested that patients aged less than 75 years who present within four hours of the onset of pain and with anterior infarction are especially likely to benefit from alteplase. However, the fact that streptokinase is far cheaper than alteplase means that it is likely to remain the most commonly prescribed thrombolytic drug.

Because streptokinase is a foreign bacterial protein it is antigenic. Anxieties have been raised about the role of antibodies to streptokinase in causing hypersensitivity reactions and their potential for neutralising …