streptokinase and Heparin lock flush Interactions

Interactions between streptokinase and Heparin lock flush (heparin)

heparin and streptokinase (Major Drug-Drug)

MONITOR CLOSELY: Although this combination is used therapeutically and recommended for certain indications (e.g., acute myocardial infarction, pulmonary embolism), fibrinolytic agents may enhance the anticoagulant effect of heparin. Data have shown that the partial thromboplastin time (PTT) may be significantly increased when fibrinogen concentrations fall in response to thrombolytic therapy. Large studies have reported that the risk of major bleeding is significantly higher when these drugs are given together. Hemorrhages have occurred during heparin infusion, one or more days after thrombolytic administration. Cholesterol embolization syndrome has also been reported rarely with thrombolytics and anticoagulants, when used alone or in combination.

MANAGEMENT: Alteplase is contraindicated in patients with acute ischemic stroke who have received heparin within the last 48 hours and have an elevated activated partial thromboplastin time (aPTT). Patients who are to receive a thrombolytic plus heparin for other indications should be carefully selected according to recommended eligibility criteria. The heparin dosage should be adjusted as appropriate to maintain therapeutic aPTT values. Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Thrombolytic and/or anticoagulation therapy should be discontinued immediately if serious or uncontrollable bleeding occurs.