| Achoimre: | Background. Anti-streptokinase immunoglobulin (IgG) induced by intravenous (IV) streptokinase (SK) can reduce the effectiveness of repeated SK use, or lead to an increased incidence of immune mediated adverse reactions. It is therefore advised that IV SK exposed patients receive an alternative fibrinolytic for later exposures. It is not known whether intra-pleural streptokinase (IPSK) induces a similar response. Methods. We studied 18 patients (age 35-81) receiving IPSK for drainage of multiloculated pleural effusion (13 infected; 5 malignant). All patients received 250,000i.u. IPSK twice daily to a maximum of 1,500,000i.u. The development of functionally important circulating antibodies against SK was assessed by comparing the inhibition of SK-induced fibrinolytic activity (Streptokinase-Resistance test) before SK administration with that 10-14 days later. Serial dilution's of SK (20μL) were added to citrated plasma (160μL) containing thrombin (20μL). The lowest concentration of SK achieving complete lysis was noted and expressed as the SK resistance titre. Results. SK resistance titres rose in 7/18 patients (39%) and in 4/18 (22%) there was at least a four-fold rise in titres. No patients had allergic reactions following IPSK administration. Conclusions. A minority of patients receiving IPSK experience a rise in functionally significant anti-streptokinase antibodies. The frequency of this rise is less than that seen following IV SK, but is sufficient to warrant the use of an alternative fibrinolytic if this is subsequently indicated.
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