STREPTOLIASUM (Streptoliasum; synonym: Streptasum, Avelysin, Distreptase, Kabikinase, Kinalysin, Streptokinase etc.) — fibrinolitic means; the fermental drug containing enzyme Streptokinasa. Receive from culture r-ge-moliticheskogo a streptococcus of group C. An effective agent of S. is Streptokinasa, a pier. the weight (weight) a cut, according to various researchers, fluctuates from 40 000 to 50 000. The page is a proteic matter (polypeptide) consisting of the remains of amino acids. Does not contain carbohydrates and phosphorus. As a part of Streptokinasa contain in significant amounts asparaginic and glutaminic to - you, there is no cystine.
In the medical practician S. use in the form of the colourless transparent solutions prepared for ex tempore from the lyophilized powder representing the porous mass of white color inodorous, easily water soluble and isotonic solutions of sodium of chloride and glucose. S.'s activity is expressed in terms of action. Take amount of drug, the lyseing certain amount of fibrin for 1 PIECE.
The village has fibrinolitic properties and at the expense of it renders thrombolytic effect. The mechanism of thrombolytic action is caused by the fact that Streptokinasa which is contained in drug activates plasminogen (plasminogen), promoting its transition to plasmin (fibrinolysin) splitting fibrin to fibrinopeptides. This effect is caused by influence of Streptokinasa on the corresponding pro-activator. The page well gets into blood clot and causes its lysis not only outside, but also from within.
At intake of S. collapses in went. - kish. path. After intravenous administration of marked S. its concentration in blood quickly decreases. The curve of elimination of drug at people does not correspond to simple exponential decrease. A part of the entered S. quickly is inactivated as a result of linkng with antibodies. In this regard a small amount of drug eliminirutsya from blood with half-life of 18 min. Part C. remaining after saturation of anti-Streptokinasas forms the activator of a fibrinolysis with plasminogen. This part C. eliminirutsya from blood with half-life of 83 min. and can get into vnososudisty spaces. In S.'s liver collects in big concentration, than in other bodies (e.g., in heart, a spleen). In the second half of pregnancy through a placental barrier only the trace number of the entered S. get into a blood stream of a fruit, to-rye, however, cause activation of fibrinolitic system of a fruit. S.'s introduction to pregnant women is followed by increase in level of anti-Streptokinasas not only in a maternal organism, but also in an organism of a fruit. At feeding S. women in insignificant quantities it can be allocated with milk. In urine after marked S.'s introduction in 2 hours 6 — 7%, and in 4 hours — apprx. 37% of the entered S. Predpolagayut's dose are found out that S. is allocated through kidneys in the form of metabolites (amino acids and peptides).
Apply Page as fibrinolitic and thrombolytic means for recovery of passability of the thrombosed blood vessels, in particular at arterial and venous fibrinferments, thrombophlebitises, fibrinferments of the central vessels of an eye, a thromboembolism of vessels of lungs, at a fresh myocardial infarction, fibrinferments of vessels of a brain, mezenterialny vessels, and also at other states proceeding with acute thrombosis and an embolism.
The drug is administered intravenously kapelno. Usually begin 250 000 PIECES of drug with introduction, dissolving it in 50 ml of isotonic solution of sodium of chloride or 5% of solution of glucose. Rate of administering makes 30 drops in 1 min. For establishment of an individual dose it is reasonable to define previously an antiserum capacity to a streptokiiaza that allows to reveal degree of resistance to drug. After introduction of an initial dose the drug continues to be administered kapelno in a dose of 750 000 PIECES in the first 6 hours with a speed of 15 thaws of 1 min. In the subsequent 6 — 7 hours and further in case of need the drug is administered at the rate of not less than 100 000 PIECES within 1 hour. After dissolution of blood clot S.'s introduction is continued during 3 — 4 hours on 250 000 — 500 000 PIECES on 250 — 300 ml of isotonic solution of sodium of chloride or 5% of solution of glucose with a speed of 15 — 30 thaws of 1 min. The general duration of introduction makes till 16 — 18 o'clock. Further treatment is continued by anticoagulants of direct and indirect action (see. Anticoagulants ). At extensive fibrinferments S.'s treatment spend longer time. Drug is most effective at fresh fibrinferments (lasting up to 5 days).
At use of high cleaning drugs C. side effects happen seldom. At persons with the high content of antibodies to S. allergic reactions in the form of urtikarny rash, an asthma, a fever, diarrhea, a bronkhosiazm, a collapse are noted. At prolonged use of S. can cause decrease in level of fibrinogen in blood and sometimes factors of V and VIII owing to what there are bleedings, for a stop to-rykh use inhibitors of a fibrinolysis, napr, aminocaproic acid, Ambenum, etc. Due to the activation of kininobrazuyushchy system under the influence of S. decrease in the ABP can be observed a nek-swarm. Besides, at S.'s use strengthening of release of a histamine owing to activation of plasmin is possible what connect the phenomena of intolerance of drug with, to-rye are shown by a headache, pains in sacral area, nausea, fever. For stopping of pains and fever use non-narcotic analgesics, napr, analginum (see). For the prevention and stopping of the anaphylactic reactions caused by S. use drugs of glucocorticoids.
Drug it is contraindicated at hemorrhagic diathesis, severe forms of sepsis and a diabetes mellitus, an idiopathic hypertensia, peptic ulcer of a stomach and duodenum, and also at a cavernous pulmonary tuberculosis, in the first 18 weeks of pregnancy and in the first 4 days after operation and childbirth.
Form of release: ampoules on 250 000 and 500 000 PIECES. In packaging on 9 ampoules, and also 1 ampoule of S. for the diagnostic purposes and 1 ampoule about thrombin test. Store at t ° 4-10 °.
See also Fibrinolitic means .
Bibliography: Andreenko G. V. Fibrinolysis (Biochemistry, physiology, pathology), M., 1979; Malinovsky H. N and Kozlov V. A. Anticoagulating and thrombolytic therapy in surgery, M., 1976; Markvardt F. and To l of EC and N d X. P. Pharmacological studying of drug of Streptokinasa — Awelysinum, Pharm. and toksikol., t. 43, No. 6, page 671, 1980, bibliogr.; Chazov E. I. and JI and-kin K. M. Anticoagulants and fibrinolitic means, M., 1977; M and to-wardt F., Landmann H. u. Klocking H. - P. Fibrinolytika und Antifibrinolytika, Jena, 1972.
K. M. Lakin.