eiiiiF 88Streptokinase
lINDICATIONS AND DOSE
Intravascular thrombosis
▶INITIALLY BY INTRAVENOUS INFUSION
▶Child 1 month–11 years:Initially 2500 – 4000 units/kg,
dose to be given over 30 minutes, followed by (by
continuous intravenous infusion)
500 – 1000 units/kg/hour for up to 3 days until
reperfusion occurs
▶Child 12–17 years:Initially250 000units, dose to be
given over 30 minutes, followed by (by continuous
intravenous infusion)100 000units/hour for up to
3 days until reperfusion occurslUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSAvoid in children who have had
streptococcal infection in the last 12 months
lCAUTIONSAtrialfibrillation.cavernous pulmonary
disease.cerebrovascular disease.mitral valve defect.
recent delivery or abortion.septic thrombotic disease
lINTERACTIONS→Appendix 1 : streptokinase
lSIDE-EFFECTS
▶Common or very commonArrhythmias.asthenia.
diarrhoea.epigastric pain.headache.infarction.malaise.
pain
▶UncommonHaemorrhage.respiratory arrest.splenic
rupture
▶Rare or very rareArthritis.eye inflammation.
hypersensitivity.nephritis.nerve disorders.neurological
effects.pulmonary oedema non-cardiogenic (caused by
reperfusion).shock.vasculitis
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
previous allergic reaction to either streptokinase or
anistreplase (no longer available). Prolonged persistence
of antibodies to streptokinase and anistreplase (no longer
available) can reduce the effectiveness of subsequent
treatment; therefore, streptokinase should not be used
again beyond 4 days offirst administration of either
streptokinase or anistreplase.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, reconstitute with Sodium Chloride 0. 9 %, then
dilute further with Glucose 5 % or Sodium Chloride 0. 9 %
after reconstitution. Monitorfibrinogen concentration
closely; iffibrinogen concentration less than 1 g/litre, stop
streptokinase infusion and start unfractionated heparin;
restart streptokinase oncefibrinogen concentration
reaches 1 g/litre.
lMEDICINAL FORMS
No licensed medicines listed.
eiiiiF 88Urokinase
lINDICATIONS AND DOSE
Occluded arteriovenous shunts, catheters, and indwelling
central lines
▶TOTHEDEVICEASAFLUSH
▶Neonate: 5000 – 25 000units, inject directly into
occluded catheter or central line, dilute dose in sodium
chloride 0. 9 %tofill catheter dead spaceonly. Leave for
20 – 60 minutes then aspirate the lysate andflush with
sodium chloride 0. 9 %.▶Child: 5000 – 25 000units, inject directly into occluded
catheter or central line, dilute dose in sodium chloride
0. 9 %tofill catheter dead spaceonly. Leave for
20 – 60 minutes then aspirate the lysate andflush with
sodium chloride 0. 9 %lCONTRA-INDICATIONSRecent stroke
lCAUTIONSAtrialfibrillation.cavernous pulmonary
disease.mitral valve defect.recent delivery.septic
thrombotic disease.severe cerebrovascular disease
lINTERACTIONS→Appendix 1 : urokinase
lSIDE-EFFECTS
▶Common or very commonArtery dissection.stroke
▶UncommonRenal failure
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lDIRECTIONS FOR ADMINISTRATIONMay be diluted, after
reconstitution, with Sodium Chloride 0. 9 %.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for injection
▶Urokinase (Non-proprietary)
Urokinase 10000 unitUrokinase 10 , 000 unit powder for solution for
injection vials| 1 vialP£ 33. 79
Urokinase 50000 unitUrokinase 50 , 000 unit powder for solution for
injection vials| 1 vialP£ 69. 70
Urokinase 100000 unitUrokinase 100 , 000 unit powder for solution
for injection vials| 1 vialP£ 106. 17
Urokinase 250000 unitUrokinase 250 , 000 unit powder for solution
for injection vials| 1 vialP£ 185. 65
Urokinase 500000 unitUrokinase 500 , 000 unit powder for solution
for injection vials| 1 vialP£ 365. 00
▶Syner-KINASE(Syner-Med (Pharmaceutical Products) Ltd)
Urokinase 10000 unitSyner-KINASE 10 , 000 unit powder for solution
for injection vials| 1 vialP£ 35. 95 (Hospital only)
Urokinase 25000 unitSyner-KINASE 25 , 000 unit powder for solution
for injection vials| 1 vialP£ 45. 95 (Hospital only)
Urokinase 100000 unitSyner-KINASE 100 , 000 unit powder for
solution for injection vials| 1 vialP£ 112. 95 (Hospital only)
Urokinase 250000 unitSyner-KINASE 250 , 000 unit powder for
solution for injection vials| 1 vialPs(Hospital only)
Urokinase 500000 unitSyner-KINASE 500 , 000 unit powder for
solution for injection vials| 1 vialPs(Hospital only)3.2 Thromboembolism
Venous thromboembolism
Venous thromboembolism prophylaxis
Low-dose heparin (unfractionated) p. 95 by subcutaneous
injection is used to prevent thrombotic episodes in‘high-
risk’patients; laboratory monitoring of APTT or anti-Factor
Xa concentration is also required in prophylactic regimens in
children. Low molecular weight heparins, aspirin
(antiplatelet dose), and warfarin sodium p. 97 can also be
used for prophylaxis.Treatment of venous thromboembolism
For the initial treatment of thrombotic episodes heparin
(unfractionated) is given as an intravenous loading dose,
followed by continuous intravenous infusion (using an
infusion pump) or by intermittent subcutaneous injection;
the use of intermittent intravenous injection is no longer
recommended. Alternatively, a low molecular weight
heparin may be given for initial treatment. If an oral
anticoagulant (usually warfarin sodium) is also required, it
may be started at the same time as the heparin (the heparin
needs to be continued for at least 5 days and until the INR
has been in the therapeutic range for 2 consecutive days).
Laboratory monitoring of coagulation activity, preferably on
a daily basis, involves determination of the activated partial
thromboplastin time (APTT) (for heparin (unfractionated)
only) or of the anti-Factor Xa concentration (for low
molecular weight heparins). Local guidelines on
recommended APTT for neonates and children should beBNFC 2018 – 2019 Thromboembolism 89
Cardiovascular system2