comparison of streptokinase and alteplase
Last reviewed 01/2018
| streptokinase | Alteplase (t-PA) | |
| molecular weight (daltons) | 47K | 70K |
| fibrin specificity | minimal | moderate |
| plasminogen binding | indirect | direct |
| potential allergic reaction | yes | no |
| plasma clearance (mins) | 15-25 | 4-8 |
| relative cost | + | +++ |
A meta-analysis of eight comparisons of standard alteplase with streptokinase found no significant difference between the two drugs in terms of mortality up to 35 days (odds ratio 1.0; 95% CI 0.94 to 1.06). A statistically significant difference in reinfarction rates in favour of alteplase was found (odds ratio 0.86; 95% CI 0.77 to 0.95). However, alteplase was associated with a statistically significant higher risk of stroke (odds ratio 1.37; 95% CI 1.16 to 1.62), due to a doubling in the risk of haemorrhagic stroke (odds ratio 2.13; 95% CI 1.04 to 4.36). However, streptokinase was associated with a statistically significant higher risk of major bleeds (other than stroke) than alteplase (odds ratio 0.81; 95% CI 0.68 to 0.97). The categorisation and reporting of major bleeding varied between the trials and so it is difficult to judge the clinical significance of these findings.
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