A Non-randomized Clinical Trial on the Effectiveness and Complications of Two Different Streptokinase Dosages in...

Streptokinase is widely used for thrombolysis in acute myocardial infarction (AMI), but concerns about complications have led to its underutilization in elderly patients. This study aimed to compare the efficacy and safety of standard-dose, i.e., 15 lakh international units (IU), versus half-dose (7.5 lakh IU) streptokinase in elderly patients with ST-elevation myocardial infarction (STEMI).

This prospective, observational study included 103 patients with STEMI aged over 70 years, admitted within 12 hours of symptom onset. Patients were divided into two groups receiving either 15 lakh IU (n = 59) or 7.5 lakh IU (n = 44) of streptokinase. Efficacy was assessed by ST-segment resolution ≥ 50% after 90 minutes. Complications and mortality were monitored in both groups.

Baseline demographic and clinical characteristics were comparable between the groups. Improvement in left ventricular ejection fraction (LVEF) from admission to one month was similar (2.75% vs. 2.84%, p = 0.885), and rates of reperfusion success (78.0% vs. 77.3%) and ST-segment resolution ≥ 50% (61.0% vs. 59.1%) did not differ significantly. Complications were more frequent in the 7.5 lakh IU group, particularly major bleeding (11.4% vs. 3.4%), though differences were not statistically significant. In-hospital mortality was low and comparable between the two groups (5.1% vs. 6.8%, p = 0.690).

Half-dose streptokinase demonstrated comparable efficacy to the standard dose in achieving myocardial reperfusion in elderly patients having STEMI.