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Pharmacological reperfusion remains the primary strategy for ST-elevation myocardial infarction (STEMI) in low- and medium-income countries. Literature has reported inconsistent incidences and outcomes of failed thrombolysis (FT). This study aimed to identify the incidence, mortality outcomes and predictors of FT in STEMI pharmacological reperfusion. This single-centre retrospective cohort study analyzed data on consecutive STEMI patients who received thrombolytic therapy from 2016 to 2020 in a public tertiary hospital. Total population sampling was used in this study. Logistic regression analyses were used to assess independent predictors of the mortality outcomes and FT. We analyzed 941 patients with a mean age of 53.0 ± 12.2 years who were predominantly male (n = 846, 89.9%). The in-hospital mortality was 10.3% (n = 97). FT occurred in 86 (9.1%) patients and was one of the predictors of mortality (aOR 3.847, p < 0.001). Overall, tenecteplase use (aOR 1.749, p = 0.021), pre-existing hypertension (aOR 1.730, p = 0.024), history of stroke (aOR 4.176, p = 0.004), and heart rate ≥ 100 bpm at presentation (aOR 2.333, p < 0.001) were the general predictors of FT. The predictors of FT with streptokinase were Killip class ≥ II (aOR 3.197, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 3.536, p = 0.001). History of stroke (aOR 6.144, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 2.216, p = 0.015) were the predictors of FT in STEMI patients who received tenecteplase. Mortality following STEMI thrombolysis remained high in our population and was attributed to FT. Identified predictors of FT enable early risk stratification to evaluate the patients' prognosis to manage them better., (© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Background: Guillain-Barre syndrome after myocardial infarction occurs infrequently, and its occurrence following percutaneous coronary intervention is extremely rare. Due to the high mortality rate of myocardial infarction and the disability of Guillain-Barre syndrome, early identification of Guillain-Barre syndrome after myocardial infarction and early intervention can decrease the mortality rate, lead to early recovery, and provide a better outcome., Case Presentation: Herein, we reported a rare case of Guillain-Barre syndrome after myocardial infarction treated with percutaneous coronary intervention. The patient was a 75-year-old woman from China who was admitted to hospital due to sudden loss of consciousness. Electrocardiography showed acute myocardial infarction in the right ventricle and inferior and posterior walls. The patient underwent emergency percutaneous intervention of the posterior collateral artery of the right coronary artery. Soon after, her condition worsened resulting in limb weakness and numbness. Unfortunately, she continued to develop respiratory failure, and treated with intravenous immunoglobulin and ventilator-assisted breathing. A physical examination showed hypotonia of all four limbs, complete quadriplegia, bulbar palsy, dysarthria, and tendon areflexia. Serum immunoglobulin (Ig) G anti-ganglioside antibody analysis was positive with anti-GT1a antibodies (+ +), anti-GM1 antibodies ( +), anti-GM2 antibodies ( +), and anti-GM4 antibodies ( +), and he was diagnosed with Guillain-Barre syndrome after myocardial infarction. She was discharged due to poor response to treatment. The patient died two days after being discharged., Conclusions: Myocardial infarction and/or percutaneous coronary intervention may activate immune-mediated response and cause severe complications. Clinician should be alert to Guillain-Barre syndrome after myocardial infarction and/or percutaneous coronary intervention., (© 2023. The Author(s).)

Cardiovascular diseases, like coronary heart disease or artery disorders (arteriosclerosis, including artery solidification), heart failure (myocardial infarction), arrhythmias, congestive heart condition, stroke, elevated vital signs (hypertension), rheumatic heart disorder, and other circulatory system dysfunctions are the most common causes of death worldwide. Cardiovascular disorders are treated with stenting, coronary bypass surgery grafting, anticoagulants, antiplatelet agents, and other pharmacological and surgical procedures; however, these have limitations due to their adverse effects. Fibrinolytic agents degrade fibrin through enzymatic and biochemical processes. There are various enzymes that are currently used as a treatment for CVDs, like streptokinase, nattokinase, staphylokinase, urokinase, etc. These enzymes are derived from various sources, like bacteria, fungi, algae, marine organisms, plants, snakes, and other organisms. This review deals with the fibrinolytic enzymes, their mechanisms, sources, and their therapeutic potential., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein (GP) IIb/IIIa inhibitor and Factor X inhibitor (Rivaroxaban) with full resolution of flow in the distal vessels. Thus, coronary lesions, not amenable to stenting, can be dealt percutaneously, using a combination of old and newer pharmacological agents without stenting.

Objective: The objective was to study whether the incidence of composite end points (mortality, cardiogenic shock and re-myocardial infarction [re-MI]) in pharmacoinvasive strategy was noninferior to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI)., Methods: This was an observational study which included 138 patients. The study included patients admitted with a diagnosis of STEMI within 24 h of symptom onset, who underwent primary PCI or pharmacoinvasive therapy in a single center over a 9-month period. Primary end points (death within 30 days, re-MI within 30 days, and cardiogenic shock) and secondary end points (arrhythmias, bleeding manifestations, ischemic stroke, ejection fraction, mechanical complications, and duration of hospital stay) were compared between the two groups at 1 month after intervention., Results: At one month follow-up, the incidence rate for primary end points was 5 events per 43 patients (11.6%) in pharmacoinvasive arm and 18 events per 95 patients (18.9%) in primary PCI arm, a difference of - 7.3% (95% confidence interval: 18.5, 7.1). This finding shows that pharmacoinvasive strategy as compared with primary PCI in the management of STEMI was equivalent in terms of composite primary outcome. There was no significant difference between the secondary outcomes between the two groups. Use of thrombus aspiration device and in turn the thrombus burden was significantly lower in the pharmacoinvasive arm., Conclusion: This observational study showed that pharmacoinvasive strategy was as good as primary PCI in STEMI, in our setting, where primary PCI may be delayed or not possible at all due to financial and logistic constraints., Competing Interests: There are no conflicts of interest

Reperfusion therapy is one of the main treatment strategies of ischemic stroke. The first studies of the efficacy of thrombolytic medications started form the use of streptokinase and fibrinolysin in patients with ischemic stroke in late 50 - early 60 of the XX century in the United States, Soviet Union, and Western Europe. After the development of recombinant tissue plasminogen activator, thrombolysis became one of the main methods of reperfusion in patients with acute ischemic stroke, acute myocardial infarction, or other acute vascular thrombotic events. Later, modified variants of tissue plasminogen activator with prolonged clearance time, high fibrin-selectivity, and bolus delivery were introduced. Another group of thrombolytic agents includes derivatives of flora and fauna - external plasminogen activators, of which streptokinase, staphylokinase, and desmoteplase are most common drugs. These medications are not a structural part of the human organism, and overcoming of immunogenicity while preserving fibrinolytic activity and fibrin specificity is one of the main tasks in applying them in clinical practice.

Formation of endogenous thrombi in blood vessels is one of the leading causes of death in our modern life. According to data provided by the World Health Organization (WHO) in 2000, heart diseases are responsible for 29% of the total mortality rate in the world. For this, a tremendous amount of research has been done in the area of prevention and treatment of these diseases. The classical therapy of these thrombi relies upon the use of antiplatelets, anticoagulants, or even surgeries. Relatively recently, the fibrinolytic enzymes produced by microorganisms, snakes, earthworms, insects, plants, and other organisms are being successfully used in the treatment of blood clots, especially with regard to the direct dissolving action on fibrin in tandem with less cost and side effects in comparison with the first-generation thrombolytic agents, streptokinase and urokinase. Furthermore, recombinant DNA technology has succeeded in improving and decreasing the undesirable effects of the first generation of enzymes. Recombinant PAs or rt-PAs like alteplase, retelase, saruplase, tenecteplase, lanoteplase, and desmoteplase became available in the drug markets with advantages of less binding loci with PAI-1 to avoid degradation while providing faster and more complete reperfusion in a greater number of patients with less risk of bleeding and intracranial hemorrhage. This review is the first to cover all the natural and recombinant thrombolytic agents used in enzyme therapy., (© 2014 American Institute of Chemical Engineers.)

Background: Fibrinolysis during ST elevation myocardial infarction (STEMI) is feasible in the emergency departments (ED), and this reduces the delay from first medical contact to coronary reperfusion. The aim of the study is to: 1) Evaluate fibrinolysis with streptokinase (SK) in STEMI admitted to the ED. 2) identify clinical criteria predictive of fibrinolysis success., Methods: prospective study (July 2008-March 2012). Inclusion of STEMI thrombolysed by SK. Fibrinolysis success was defined according to clinical and Electrocardiogram criteria. Multivariate study is used to identify the factors associated with thrombolysis success., Results: Out of the 329 STEMI enrolled during the study period, 224 (68%) were thrombolysed. Mean age = 57 ± 11 years (20-86 years) sex ratio = 6. The average time chest pain - emergency admission was 195 ± 177 min (15 min to 12 hours). The 2/3 of patients had consulted during the first 3 hours. The average success rate of thrombolysis was 59% and reached 83% the first hour, 66% the second hour and 58.7% the third hour. In multivariate analysis, the three independent predictors factors of a fibrinolysis success were: active smoking, current treatment with beta blockers and the delay from onset chest pain to the ED visit less than 180 min. Conversely, diabetes was associated with fibrinolysis failure. Fibrinolysis got complicated by two intracerebral hemorrhages. Three patients had died in the ED., Conclusion: Two thirds of patients with STEMI have consulted 3 h after onset of chest pain. Fibrinolysis with streptokinase was effective in 59% of cases.

We evaluated the relationship between baseline factors defined at 4.6 +/- 2.1 hr after onset of acute myocardial infarction and 1 year survival in 245 patients entered in the Western Washington Intracoronary Streptokinase Trial. Univariate statistics identified a significant relationship between 10 of these factors and survival. Multivariate analysis identified three factors as being most closely related to survival: (1) left ventricular ejection fraction (LVEF) (p less than .0001), (2) treatment with streptokinase (p = .03), and (3) location of infarction (p = .04). Mathematic models based on this analysis and applied to our patients identified high- and low-risk subgroups for 1 year mortality. Patients receiving standard, not interventional, therapy with anterior infarction and an LVEF of 50% or less and those with inferior infarction and an LVEF of 39% or less comprised the high-risk group. For patients receiving standard therapy, 1 year mortality was 41% in the high-risk group and 4% in the low-risk group. The models illustrated the magnitude of benefit of streptokinase treatment and achievement of complete reperfusion for those at low and high risk. We conclude that LVEF determined in the first hours of acute myocardial infarction is the most important of all baseline factors for prediction of 1 year survival. Mathematic models based on left ventricular function measured as ejection fraction are useful for risk stratification in this setting.

Objectives: This study aims to evaluate the knowledge and proficiency of nurses in managing thrombolytic therapy for myocardial infarction. Methodology: A cross-sectional research design was adopted and conducted in a public teaching hospital from May 2020 to September 2020. Registered professional nurses (n=52) working in the emergency department (ED) and cardiac care unit (CCU) were invited to participate. A structured, pre-validated questionnaire was used for data collection. The study received approval from the institutional review board and ethics committee. Data were analyzed using SPSS version 25.0. Results: Fifty ED nurses participated in the study, predominantly male, aged = 34 years, with = 3 years of experience. The overall knowledge score of nurses regarding thrombolytic therapy was 71%, while the practice score was 79%. The lowest level of knowledge was related to contraindications (65%) and treatment protocols (66%), while the highest was for therapy considerations (85.2%). The lowest task performance (47.8%) was observed in the pre - administration phase. There was a negative correlation (r = -0.226) between knowledge and practice. Knowledge levels were higher among male nurses, while task performance was better among those with cardiac certification. Conclusion: The study revealed that while nurses had a favorable level of knowledge about thrombolytic therapy, their practical implementation was poor. This gap highlights the need for targeted educational programs and the establishment of efficient documentation systems to enhance clinical practice. [ABSTRACT FROM AUTHOR]

Bleeding complications following thrombolytic treatment for acute myocardial infarction (AMI) are not infrequent, among which intracranial hemorrhage is commonly reported. In contrast, retroperitoneal hematoma following the administration of thrombolytics is rarely reported in the literature. We are reporting a case of a middle‐aged man, who presented with left‐sided chest pain and was diagnosed with acute coronary syndrome with anterior wall ST elevation AMI. The patient was administered with thrombolytic drugs, including streptokinase and heparin. Percutaneous coronary intervention in the form of Coronary angioplasty with stent insertion was done to the left anterior descending artery, given coronary artery disease. The blood investigations showed elevated activated partial thromboplastin time and prothrombin time. The patient developed vomiting, altered sensorium, and left‐sided weakness, and a non‐contrast computerized tomography brain was done, which showed acute hemorrhage involving the right frontal lobe with intraventricular extension, so the ventricular drain was placed. The patient developed cardiac arrest and died on the third day. On autopsy examination, the brain showed subarachnoid hemorrhage, intraparenchymal hemorrhage over the right frontal lobe, and clotted blood in all the ventricles. A retroperitoneal hematoma of around 1500 cc was seen over the left side of the peritoneal cavity. This case highlights that although intracranial hemorrhage is a known complication after administrating thrombolytic therapy, clinicians should also be aware of the possibility of retroperitoneal hemorrhage. This case emphasizes the value of an autopsy in determining the cause of death in such situations. [ABSTRACT FROM AUTHOR]

Streptokinase is being successfully used as a thrombolytic agent for restoring the blood flow following thromboembolism and myocardial infarction. However, high immunogenicity of the drug has limited its use in clinics. To overcome this limitation, several approaches including PEGylation, use of polymeric particles and liposomes have been suggested. Here, an overview of options for encapsulating the streptokinase has been provided. The suggested options in the literature include PEGylation, polymeric nano/micro-capsules and liposomes. In each approach, efficacy, side effect(s) and pharmacokinetic profile of streptokinase has been evaluated. The data show that while efficacy of streptokinase does not appear to change importantly, side effects and pharmacokinetics have been improved. [ABSTRACT FROM AUTHOR]

Introduction: A myocardial infarction (MI), commonly known as a heart attack, is the result of a sudden interruption in the blood flow to the heart muscle. This is frequently caused by a blood clot forming within the coronary arteries. Acute myocardial infarction (AMI) is a major health hazard that causes over a million deaths annually in the US and affects up to 3 million people globally. Thrombolytic therapy, such streptokinase, is used to break up blood clots and improve blood flow, which stops ischemia injury. Injectable streptokinase is used to activate plasminogen in a nonenzymatic manner. Material And Method: This study examined thrombolytic outcomes in 120 patients with ST elevation myocardial infarction (STEMI) using a prospective interventional trial design. Patients were grouped according to gender and diabetes status. A thorough statistical analysis was carried out, looking at the relationship between gender and diabetes status and thrombolytic outcomes. Measurements such as glucose levels, ECG results, and random blood sugar were examined. Result: There were notable differences in ST segment resolution between MI patients with diabetes and those without. Of the 70 diabetic MI patients, 61.42% had failed thrombolysis (less than 30% ST resolution), whereas 21.42% had successfully completed thrombolysis (more than 70% resolution) (p=0.003). Compared to diabetics, non-diabetic MI patients (n=50) had a greater success rate (44%) and a higher percentage of failed thrombolysis (24%; p=0.049). Anterior wall MI was more common in both groups, followed by inferior wall MI, while anteroseptal MI was less common. Men with diabetes (n = 45) demonstrated 23 failed, 10 partial, and 12 effective resolutions; women with diabetes (n = 25) demonstrated 11 failed, 9 partial, and 5 successful resolutions. Non-diabetic females (n=25) had only two instances of unsuccessful resolution, compared to three among non-diabetic males (n=25). Conclusion: When comparing the thrombolytic effects of streptokinase, patients with diabetes had a higher incidence of unsuccessful thrombolysis (less than 30% ST resolution) than their non-diabetic counterparts. On the other hand, non-diabetic STEMI patients are more likely to have effective thrombolysis (>70% ST resolution). This highlights the effect of type 2 diabetes on the results of thrombolysis. Given the documented difficulties in establishing successful thrombolysis in this subgroup, percutaneous coronary intervention may therefore be preferred to thrombolysis in diabetic STEMI cases. [ABSTRACT FROM AUTHOR]

Abstract Background Guillain–Barre syndrome after myocardial infarction occurs infrequently, and its occurrence following percutaneous coronary intervention is extremely rare. Due to the high mortality rate of myocardial infarction and the disability of Guillain–Barre syndrome, early identification of Guillain–Barre syndrome after myocardial infarction and early intervention can decrease the mortality rate, lead to early recovery, and provide a better outcome. Case presentation Herein, we reported a rare case of Guillain–Barre syndrome after myocardial infarction treated with percutaneous coronary intervention. The patient was a 75-year-old woman from China who was admitted to hospital due to sudden loss of consciousness. Electrocardiography showed acute myocardial infarction in the right ventricle and inferior and posterior walls. The patient underwent emergency percutaneous intervention of the posterior collateral artery of the right coronary artery. Soon after, her condition worsened resulting in limb weakness and numbness. Unfortunately, she continued to develop respiratory failure, and treated with intravenous immunoglobulin and ventilator-assisted breathing. A physical examination showed hypotonia of all four limbs, complete quadriplegia, bulbar palsy, dysarthria, and tendon areflexia. Serum immunoglobulin (Ig) G anti-ganglioside antibody analysis was positive with anti-GT1a antibodies (+ +), anti-GM1 antibodies ( +), anti-GM2 antibodies ( +), and anti-GM4 antibodies ( +), and he was diagnosed with Guillain–Barre syndrome after myocardial infarction. She was discharged due to poor response to treatment. The patient died two days after being discharged. Conclusions Myocardial infarction and/or percutaneous coronary intervention may activate immune-mediated response and cause severe complications. Clinician should be alert to Guillain–Barre syndrome after myocardial infarction and/or percutaneous coronary intervention.

Background: Two-dimensional speckle-tracking echocardiography (2D STE) has been proven to be more accurate than prognostic metrics such as the left ventricular ejection fraction (LVEF) and wall motion score index (WMSI). Aim: To contrast the effectiveness of primary percutaneous coronary intervention (PCI) versus Streptokinase based pharmacoinvasive technique in ST elevation myocardial infarction (STEMI) patients. Patients and Methods: In this observational cross section research, 100 patients with acute STEMI were enrolled. They were then divided into two groups: Group A, which included 50 patients who underwent primary PCI as a reperfusion strategy, and Group B, which included 50 patients who underwent pharmacoinvasive technique, which involved streptokinase IV infusion, over the course of a year from November 2020 to November 2021. In order to evaluate the main outcome, which was LV systolic function, all patients had a thorough medical history review, physical examination, 12-lead surface ECG, and echocardiogram (2D global longitudinal strain [GLS] utilizing speckle tracking echocardiography [STE]. Results: Pre-intervention GLS showed no statistically substantial variation between the two groups (p=0.768), however post-treatment GLS showed statistically substantial variations between the two groups (p=0.004) and regarding change (%) GLS (p=0.001). Conclusion: Primary PCI remains the best option for resolving ischemia. When compared to IV streptokinase treatment, direct coronary angioplasty exhibited a substantial clinical advantage. To treat the myocardial infarction, it was superior to streptokinase based pharmacoinvasive therapy. [ABSTRACT FROM AUTHOR]

Esophageal Intramural Haematoma (EIH) is a rare entity usually caused by repeated emesis or trauma. It is diagnosed on the basis of upper gastrointestinal endoscopy and radiology.Treatment is conservative unless hemodynamic instability prevails. Use of anticoagulation or thrombolytic therapy is believed to be a risk factor rather than a causative etiology. However,a review of literature shows only few cases occurring post-thrombolysis. We report about a patient of myocardial infarction who was thrombolyzed with streptokinase. He developed hematemesis and dysphagia a few hours after thrombolysis despite ECG resolution of his ST elevation. He was diagnosed to have EIH on basis of endoscopic and computed tomographic findings. His symptoms improved within two weeks, and a repeat UGIE showed resolution of the hematoma.

Imtinene Ben Mrad,1 Melek Ben Mrad,2 Zeineb Oumaya,1 Ihsen Zairi,1 Boutheina Besbes,1 Khalil Ouaghlani,1 Sofien kamoun,1 Sobhi Mleyhi,2 Rim Miri,2 khadija Mzoughi,1 Sondos Kraiem1 1Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia; 2Cardiovascular Surgery Department, Rabta Hospital, Tunis, TunisiaCorrespondence: Imtinene Ben MradCardiology Department, Habib Thameur Hospital, App 2b, Bloc 12, cite Olympique, Tunis, 1003, TunisiaTel +011 216 20156852Email imtinenebenmrad12@gmail.comAbstract: Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate, characterized by extensive bleeding into the alveolar spaces. AH secondary to systemic thrombolysis treatment in the setting of acute myocardial infarction is an uncommon complication, but potentially fatal and can lead to acute respiratory failure. This entity is rarely reported in the literature. We report two cases of acute AH after intravenous thrombolysis for acute myocardial infarction, which could contribute to the literature on the subject, and discuss the risk factors as well as the clinical and radiological findings supporting the diagnosis. We overview also the rare previous published case reports in this context, and we contrast our findings with those reported in the literature.Keywords: hemoptysis, alveolar hemorrhage, myocardial infarction, fibrinolytic therapy, streptokinase

Early administration of thrombolytic agents is the standard treatment and crucial for the outcome for patients presenting with acute myocardial infarction (MI). This study was conducted to evaluate the door to needle time of streptokinase administration and the left ventricular function in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI who were received streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the case group and compared with acute and recent phases in the control group. The left ventricular function in 5 and 42 days after emergency department arrival was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants (45 streptokinases, 42 non-streptokinase), there was a significant relationship between the door to needle time in patients who received streptokinase in 1 hour (P=0.000), 3 hours (P=0.007), and 6 hours (P=0.016) after onset the chest pain and an ejection fraction of the patients in 5 days after hospitalization. Also, there was a significant relationship between ejection fraction in 5 days (P=0.000) and 42 days (P=0.000) of administration streptokinase and door to needle time. Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia. [ABSTRACT FROM AUTHOR]

Early administration of thrombolytic agents is standard for patients presenting with acute myocardial infarction (MI). Also, prolonged QT intervals indicate a higher risk for sudden death in patients with MI. This study was conducted to evaluate the door to needle time of streptokinase administration and the incidence of life-threatening arrhythmia in patients with anterior MI. This study was a prospective, singlecenter study on participants with anterior MI, who were divided into streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the group and compared with acute and recent phases in the non-streptokinase group. The incidence of life-threatening arrhythmia was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants, there was a significant relationship between the door to needle time of 30 minutes and QTc interval in the hyperacute phase (P=0.005). Also, QTc in the streptokinase group was significantly lower than the non-streptokinase group in the acute phase (P=0.003 vs. P=0.205) and recent phase (P=0.007 vs. P=0.228). The incidence of fatal arrhythmias in the streptokinase group was lower than in the others. The relationship between the incidence of VT/VF and TIMI flow grade was insignificant (P=0.089). Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia. [ABSTRACT FROM AUTHOR]

Indigofera cassioides Rottl. Ex. DC. is a large shrub, distributed throughout the hills of India. Because of its reported robust antioxidant potential and phytoconstituents content, we were interested in investigating the in vitro thrombolytic and in vivo cardioprotective effect of methanolic leaves extract of Indigofera cassioides. An in vitro thrombolytic model was used to evaluate the clot lysis effect of different concentrations of Indigofera cassioides along with streptokinase as a positive control and distilled water as a negative control. Cardioprotective activity of methanolic leaves extract of Indigofera cassioides has been evaluated in isoproterenol-induced myocardial infarction in rats. The treatment was designed as four groups of six animals each as follows. Group I: Control, Group II: Isoproterenol alone, Group III: Methanolic leaves extract of Indigofera cassioides (200 mg/kg) and Group IV: Methanolic leaves extract of Indigofera cassioides (400 mg/kg). To evaluate the efficacy of methanolic leaves extract of Indigofera cassioides treatment against isoproterenol-induced myocardial damage, biochemical parameters and histopathological studies were carried out. High-performance thin-layer chromatography fingerprint analysis of methanolic leaves extract of Indigofera cassioides revealed the presence of terpenoid and flavonoid compounds. Methanolic leaves extract of Indigofera cassioides shows a dose-dependent clot lysis effect. Isoproterenol-induced animals exhibited significantly altered lipid profile, alanine transaminase, aspartate transaminase, alkaline phosphatase and also elevate serum cardiac activity markers creatine phosphokinase-myocardial band and lactate dehydrogenase, which were reversed near to normal levels in the pre-treatment of methanolic leaves extract of Indigofera cassioides. In conclusion, methanolic leaves extract of Indigofera cassioides exhibited significant thrombolytic activity which might be an aid to reduce the myocardial infarction. The cardioprotective effect of methanolic leaves extract of Indigofera cassioides was confirmed by the reduction in cardiac marker enzymes, altered lipid profile and protection histopathological changes on heart tissues. [ABSTRACT FROM AUTHOR]

Alveolar hemorrhage following thrombolytic agents administration is an extremely rare entity that has only been reported in twenty two patients in the medical literature. We herein report a case of a 60-year old male with an acute ST-elevation myocardial infarction who was treated with Streptokinase. Twelve hours after streptokinase adminstration, the patient developed severe hemoptysis and dyspnea and radiological studies were highly suggestive for acute alveolar hemorrhage. His past medical history is significant for severe chest trauma ten months prior to presentation.. Conservative therapy in addition to anti-coagulants withdrawal has led to gradual improvement in the next six days. We also discussed the aspects of our patient in comparison with published cases. [ABSTRACT FROM AUTHOR]

Acute Myocardial Infarction (AMI) is the immediate cessation of the blood supply to the heart muscle and occurs due to lack of oxygen and is one of the most frequent medical emergencies. ST-Elevation Acute Myocardial Infarction (STEMI)is one of the major cardiological emergencies which is associated with complications of heart failure, arrhythmia, and high mortality. The main treatment is coronary artery recanalization of the involved artery in the shortest time possible. Percutaneous transluminal coronary angioplasty has shown the best results of AMI treatment. Reperfusion of the ischemic myocardium can be achieved by pharmacologic methods (thrombolysis) and PCI (Percutaneous Coronary-arteries Intervention). Purpose of the study: The study is of cohort-prospective type. It is a study for the coronary-angiography evaluation of the current treatment of STEMI at the University Hospital Center in Tirana in patients undergoing thrombolysis with streptokinase or reteplase (choice is based on the specific case), and the effect of predisposing factors upon the mortality of STEMI. Materials and methods: this study included all patients admitted to the department of cardiologic resuscitation, from 01 Feb 2013, until 05 Jul 2013 (56 patients, of whom 26 were females and 30 were males, with an identical average age of 56.0 ±10.0 years old) diagnosed with STEMI in whom thrombolysis with reteplase or streptokinase has been performed according to previously tested protocols, respecting the absolute contraindications for the application of reperfusion procedure. Thrombolysis was performed in patients who presented within 6 hours since the onset of pain. Follow-up includes days of hospitalization (cardiology resuscitation + cardiology clinic I or II). Results: Data analysis showed Thrombolysis in Myocardial Infarction (TIMI) 3 in 82% of the total cases; The group of patients treated with streptokinase showed TIMI 3 of 70% and the group of patients treated with reteplase showed TIMI 3 of 91%. The total mortality rate was 6.9% (3 patients) and these were part of the group treated with reteplase. Predisposing factors for high mortality in patients undergoing thrombolysis such as age, sex, diabetes mellitus (DM) type II (prevalence of DM type II was 33.9% of all patients, of whom 41% of the patients treated with RP and 22% of patients treated with ST, p=0.0001) and TIMI had a statistical significantly higher risk factors in the group treated with reteplase. Conclusion: Thrombolysis of STEMI patients presents an effective recanalizing alternative when the patient presents within the first few hours since the onset of pain onset, a conclusion achieved by TIMI-based coronary angiography assessment. Mortality in thrombolysis is related to factors such as: age, gender, high blood pressure (BP), DM, and other comorbid factors. [ABSTRACT FROM AUTHOR]

Clotting of blood is the vital processes and a perplexing interaction of various mechanisms of circulatory system due of failure of which is sometimes considered as a concern within the circulatory system causing acute myocardial or cerebral infarction which might cause demise. Sida acuta burm. f (Malvaceae) is abundantly growing small perennial shrub utilized by natives for diuretic, anthelmintic, calmative and wound healing properties, and are utilized in treating disorders like blood, bile, liver, nervous, urinary diseases and rheumatism. The present study was intended to evaluate the blood clot dissolving potential of Sida acuta leaf aqueous extract in vitro. The plant material as leaves were locally collected and subjected to phytochemical extraction with distilled water. The preliminary phytochemical tests total phenolic content was estimated by Folin-Ciocalteu’s method. In vitro thrombolytic activity of 3 different concentrations of aqueous extract was estimated on goat blood clot compared to the activity of streptokinase. The aqueous extract of S. acuta leaves are reported to be rich in alkaloids, flavonoids, tannins, terpenoids and glycosides while the total phenolic content was estimated to be 17.48 % in extract which are mostly responsible for any pharmacological activity. Compared to the thrombolytic activity of standard streptokinase which was 73 %, the aqueous leaf extract of S. acuta displayed considerable blood clot dissolving activity at concentration 10 mg/100μl, 5.0 mg/100μl, and 2.5 mg/100μl as 41 %, 34 % and 12 % respectively. This property of plant extract is promising which could be could be exploited in development of new biopharmaceutical and therapeutic agents after stringent further physiological compatibility and in vivo pharmacological studies. [ABSTRACT FROM AUTHOR]

Background: Hypotension is a common adverse drug reaction that occurs during Streptokinase (SK) infusion. Despite this, there is paucity of data available to prevent and manage this reaction. Objective: We conducted a study to determine the occurrence pattern and predict risk factors associated with this reaction. Setting: The study was conducted in a tertiary care hospital. Methods: Data from 183 patients that were given SK for ST Elevations Myocardial Infarctions in 2018 and 2019 were retrieved. Main outcome measure: Systolic Blood Pressure (SBP) measurements and corresponding durations during the occurrence of this reaction were obtained. Results: Hypotension was reported as the most common adverse drug reaction that occurred among 22.4% of patients in the study. SK induced hypotension occurred at a median (IQR) of 15(13) minutes after starting SK infusion. Hypotensive episode recovered in a median duration of 15(10) minutes with appropriate interventions. Apart from temporarily withholding SK, most patients (58.5%) required a combination of fluid therapy and vasopressor support to restore SBP. Although duration of SK infusion was prolonged in all patients (20.7 ± 13.5 minutes), interventions instituted were shown to be successful in restoring SBP. Patients with inferior MI were shown to be a significant predictor for the occurrence of SK induced hypotension (OR =2.34; 95% CI = 1.16 – 4.74; p-value = 0.018). Conclusion: The risk and benefit of administering SK to inferior MI patients must be assessed and effective strategies can be implemented to ensure SK treatment is safe to all STEMI patients [ABSTRACT FROM AUTHOR]

Esophageal Intramural Haematoma (EIH) is a rare entity usually caused by repeated emesis or trauma. It is diagnosed on the basis of upper gastrointestinal endoscopy and radiology. Treatment is conservative unless hemodynamic instability prevails. Use of anticoagulation or thrombolytic therapy is believed to be a risk factor rather than a causative etiology. However, a review of literature shows only few cases occurring post-thrombolysis. We report about a patient of myocardial infarction who was thrombolyzed with streptokinase. He developed hematemesis and dysphagia a few hours after thrombolysis despite ECG resolution of his ST elevation. He was diagnosed to have EIH on basis of endoscopic and computed tomographic findings. His symptoms improved within two weeks, and a repeat UGIE showed resolution of the hematoma. [ABSTRACT FROM AUTHOR]

Introduction: Despite the common occurrence of streptokinase-induced hypotension among patients with acute myocardial infarction, the underlying pathophysiology remains obscure and poorly understood. Our study aimed to pool clinical evidence on the potential mechanism of streptokinase-induced hypotension through a systematic review of the literature. Material and methods: We conducted literature search from Medline, Scopus and Web of Science on clinical studies related to streptokinase-induced hypotension. Results: Our search yielded 972 citations. After removal of duplicates, 878 articles were screened for eligibility, of which 856 papers were excluded due to various reasons. Of the remaining 22 articles retrieved with full texts, eight relevant articles were selected for final analysis. Three themes emerged as the proposed mechanisms of streptokinase-induced hypotension, including (i) reduction in total peripheral resistance, (ii) complement activation, and (iii) dismissal of hypotheses involving other intermediaries. Conclusions: Our findings suggest that the underlying mechanism of streptokinase-induced hypotension lies primarily in the reduction in total peripheral resistance. [ABSTRACT FROM AUTHOR]

Background: Although recombinant tissue plasminogen activator has become the first-line thrombolytic agent, streptokinase remains in use in acute ST-elevation myocardial infarction (STEMI) patients in Malaysian public hospitals. In a state hospital in Malaysia, all post-STEMI patients given streptokinase are counselled and issued with a streptokinase card by pharmacists. Due to its highly antigenic nature, patient knowledge of streptokinase and the streptokinase card serve as important alerts to healthcare providers. This study aimed to develop a validated questionnaire on evaluating knowledge of streptokinase and the streptokinase card among post-STEMI patients. Methods: A Malay language questionnaire was developed based on literature review and a standard streptokinase counselling checklist. The questionnaire consisted of three parts: demographics, knowledge of streptokinase and understanding of streptokinase card. The content of the questionnaire was revised by eight experts (emergency specialists, physicians and pharmacists) and six patients were interviewed via telephone, 2 weeks after being issued with a streptokinase card, to test for comprehensibility. Then, a telephone survey was conducted during June-December 2017 involving another 60 patients to test for construct validity and reliability. Results: The questionnaire was finalised by decreasing the overall number of items from 6 to 5 (Section B) and 6 to 4 (Section C). The overall measurement of sample adequacy (MSA) was 0.758. Bartlett's test was highly significant (<0.001). The Cronbach's alpha values for Sections B and C were 0.747 and 0.841, respectively. Conclusion: Our nine-item questionnaire is a valid and reliable instrument to assess knowledge of streptokinase and the streptokinase card among Malaysian post-STEMI patients. [ABSTRACT FROM AUTHOR]