Vasculitis complicating treatment with intravenous anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.

Abstract

In six patients (five male, one female) a purpuric rash developed 7-15 days after the administration of anisoylated plasminogen streptokinase activator complex. In each case there was purpura, particularly of the extensor surfaces of the legs. In two patients the rash also affected the extensor surfaces of their arms. The lesions varied from areas of purpura (3-7 mm in diameter) to necrotic vesicles (figure). The rash began to resolve after 2-5 days and had completely disappeared after three weeks. The table gives further details of the patients.Five of the six patients developed arthralgia with swelling around their ankles as well as the rash. Of these, three had abdominal distension with colicky abdominal pain and diarrhoea. One patient with abdominal symptoms had melaena; endoscopy showed that the gastric mucosa was purpuric. These abdominal symptoms had a similar time course to the rash. No patient had clinical evidence of progressive renal impairment, although urinalysis showed mild proteinuria and haematuria in two patients.No fall in haemoglobin concentration was detected, even in the patient who had melaena. Similarly, the platelet counts in each patient remained

Low Incidence of Antibodies to Recombinant Human Tissue-Type Plasminogen Activator in Treated Patients

“…Antibodies to SK arise naturally following exposure to bacteria of the genus streptococcus and are present in virtually all individuals tested (43). Therapeutic administration of SKcontaining thrombolytics leads to an anamnestic response with increased production of antibodies, decreased rates of thrombolysis, and subsequent immunologic complications such as anaphylaxis, vasculitis or serum sickness in some treated patients (28)(29)(30)(31)(32)(33)(34). Because t-PA is a naturally occurring human protein, it should not be immunogenic in humans.…”

“…The effects of these antibodies may be completely benign, or they may lead to the neutralization of the drug's biological activity or to toxicity due to immune complex formation. In particular, in the field of thrombolytic therapy, preexisting antibodies to the bacterial protein streptokinase (SK) have resulted in decreased rates of thrombolysis (24)(25)(26)(27), immune complex disease (28)(29)(30)(31) or anaphylaxis (31)(32)(33)(34) in patients treated with SK or its derivative, anisoylated plasminogen SK activator complex. Therefore, in spite of the fact that rt-PA is a highly purified glycoprotein, identical in primary structure to the human protein (35), sera from rt-PA treated patients were tested for the presence of antibodies to t-PA.…”

Safety and efficacy of repeat thrombolytic treatment after acute myocardial infarction.

“…4 Vasculitis has also been reported after treatment with anistreplase. 25 Readministration of plasminogen activators such as tissue plasminogen activator and urokinase, which are non-allergenic, is less likely to reduce efficacy and cause allergic reactions. Little is known of the risks of readministration of these agents, however, particularly of haemorrhage during the first few days after initial treatment.…”

Drug Points: Iritis after treatment with streptokinase

“…Immediate reactions include bronchospasm, urticaria, and anaphylaxis 1. Delayed reactions include vasculitis and an illness like serum sickness 2 3. Kinshuk suggested that iritis may be associated with streptokinase treatment 4.…”