Is streptokinase still used?

It is still used in some regions for cost and availability reasons, but in many countries it has been largely replaced by fibrin-specific agents such as alteplase and tenecteplase.

Why can't streptokinase be given twice?

It is a bacterial protein, so the body produces neutralizing antibodies. Repeat dosing can be both ineffective and more likely to cause allergic reactions, so re-administration is generally avoided.

What are the most serious risks?

The most serious risk is bleeding, including intracranial hemorrhage. Hypotension during infusion and allergic/anaphylactoid reactions are also important hazards.

Can I obtain or use streptokinase myself?

No. It is a prescription emergency medicine given intravenously by clinicians with monitoring and resuscitation support; it is not appropriate for any self-administration.

EMA-approvedaka Streptase

Streptokinase — Complete Research Guide (2026)

Last updated 2026-06-30

TL;DR

Streptokinase (also known as Streptase) is a peptide catalogued under Enzymes (Fibrinolytic). Neutral reference entry; EU status: EU-approved prescription medicine.

What is Streptokinase?

Streptokinase is a bacterial (beta-hemolytic Streptococcus-derived) fibrinolytic protein historically approved for acute myocardial infarction, pulmonary embolism, deep vein thrombosis, and arterial thrombosis. It is a prescription hospital/emergency medicine, supported by large landmark randomized controlled trials (GISSI-1, ISIS-2), and is not a research or wellness peptide.

In higher-resource settings it has been largely superseded by fibrin-specific agents (alteplase, tenecteplase), though it remains used where cost or availability is the deciding factor.

How does Streptokinase work?

Streptokinase binds plasminogen to form an activator complex that converts circulating plasminogen into plasmin, the enzyme that degrades fibrin and dissolves thrombi.

Because it is not fibrin-specific, it also breaks down circulating fibrinogen, producing a systemic lytic state.

What does the research say about Streptokinase?

Given early in acute myocardial infarction, intravenous streptokinase significantly reduces mortality versus standard care. ^[1]
Combining streptokinase with aspirin further lowers vascular mortality after suspected acute MI, more than either agent alone. ^[2]
Streptokinase reopens the infarct-related coronary artery, though it restores full patency less often and more slowly than accelerated tissue plasminogen activator. ^[4]

Clinical research & studies

The references below are the primary sources cited throughout this guide. Each links directly to PubMed or the regulator. Where evidence is preclinical (animal or in-vitro), that is stated rather than implied.

[1] Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) — GISSI Collaborative Group, Lancet 1986. (Randomized controlled trial)
[2] Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2 — ISIS-2 Collaborative Group, Lancet 1988. (Randomized controlled trial)
[3] An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction — GUSTO Investigators, New England Journal of Medicine 1993. (Randomized controlled trial)
[4] The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction — GUSTO Angiographic Investigators, New England Journal of Medicine 1993. (Randomized angiographic substudy)
[5] A history of streptokinase use in acute myocardial infarction — Sikri N et al., Texas Heart Institute Journal 2007. (Historical review)
[6] T-cell recognition of discrete regions of the thrombolytic drug streptokinase — Lawley WJ et al., Clinical Science (London) 2000. (Immunology study)

Dosing context

This is not medical advice or a usage recommendation. Dosing figures are reported research context only, cited from the published literature.

For context only and not as guidance: streptokinase for acute MI was historically given as roughly 1.5 million IU intravenously over 30-60 minutes, with weight- and indication-specific regimens for pulmonary embolism or DVT.

It is administered exclusively by medical professionals in a hospital or emergency setting with resuscitation support available.

Side effects & safety profile

Streptokinase carries a serious bleeding risk, including potentially fatal intracranial hemorrhage, and commonly causes hypotension during infusion.

Because it is a foreign bacterial protein it is antigenic: it can trigger allergic and anaphylactoid reactions and induces neutralizing antibodies; those antibodies mean re-administration (from days to years after a first dose or a streptococcal infection) can be ineffective and unsafe, so streptokinase generally should not be reused.

Administration is strictly by clinicians in a monitored acute-care setting.

Stacking & combinations

Streptokinase is used with aspirin in acute MI (which improves survival) and alongside anticoagulants, but any combination that adds antiplatelet or anticoagulant effect increases bleeding risk and is a clinician-only decision.

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Frequently asked questions

It is a clot-dissolving (fibrinolytic) drug historically used for acute myocardial infarction, pulmonary embolism, deep vein thrombosis, and other arterial or venous thrombosis in a hospital setting.

References

[1] Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) — GISSI Collaborative Group, Lancet 1986. PMID: 2868337. View sourceStudy: Randomized controlled trialEarly intravenous streptokinase reduced in-hospital mortality after acute MI, with greatest benefit when given soonest.
[2] Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2 — ISIS-2 Collaborative Group, Lancet 1988. PMID: 2899772. View sourceStudy: Randomized controlled trialStreptokinase and aspirin each reduced vascular mortality, and their combination was additive.
[3] An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction — GUSTO Investigators, New England Journal of Medicine 1993. PMID: 8204123. View sourceStudy: Randomized controlled trialAccelerated t-PA reduced 30-day mortality compared with streptokinase-based regimens.
[4] The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction — GUSTO Angiographic Investigators, New England Journal of Medicine 1993. PMID: 8232430. View sourceStudy: Randomized angiographic substudyStreptokinase achieved lower early infarct-artery patency than accelerated t-PA.
[5] A history of streptokinase use in acute myocardial infarction — Sikri N et al., Texas Heart Institute Journal 2007. PMID: 17948083. View sourceStudy: Historical reviewReviews streptokinase's development, pivotal trials, antigenicity, and its displacement by fibrin-specific agents.
[6] T-cell recognition of discrete regions of the thrombolytic drug streptokinase — Lawley WJ et al., Clinical Science (London) 2000. PMID: 11787478. View sourceStudy: Immunology studyCharacterizes immune recognition of streptokinase, underpinning its antigenicity and neutralizing-antibody response.

This article is for educational and research purposes only. Peptides discussed here are not approved for human consumption by the FDA, EMA, or equivalent regulators outside of specific clinical contexts. Always consult a licensed medical professional before any therapeutic use.