Streptokinase in Thrombolytic Therapy From Mechanism to Clinical Practice

Streptokinase is a well-established thrombolytic agent widely used in the treatment of thromboembolic disorders such as acute myocardial infarction, ischemic stroke, pulmonary embolism, deep vein thrombosis, and neonatal thrombosis. It is a non-fibrin-specific plasminogen activator produced by β-hemolytic streptococci that promotes fibrinolysis by converting plasminogen to plasmin, resulting in clot dissolution. Despite the availability of newer fibrin-specific agents like tissue plasminogen activator, streptokinase remains extensively used in developing countries due to its cost-effectiveness and proven clinical efficacy. Experimental studies show that its thrombolytic efficiency depends on clot composition and age, while microbiological studies highlight improved production through strain selection and genetic modification techniques. Clinical investigations demonstrate improved reperfusion and metabolic recovery when streptokinase is administered early, although it is associated with higher systemic fibrinolysis and bleeding risk. Recent advances focus on recombinant approaches and combination therapies to enhance safety and efficacy, emphasizing the continued relevance of streptokinase in thrombolytic therapy.