The Effect of Streptokinase Neutralizing Antibodies on Thrombolytic Activity in Double Lumen Cuffed Catheter

Document Type : Original Article (s)

Authors

1 Assistant Professor, Isfahan Kidney Disease Research Center, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Internal Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Isfahan Kidney Disease Research Center, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Streptokinase is the only available thrombolytic agent in some areas. Streptococcal infection induces streptococcal antibodies and these antibodies increase failure rate in response to Streptokinase. This study was designed to investigate the effect of neutralizing antibodies on therapeutic effect of streptokinase to treat lumen cuffed catheter occlusion.Methods: In this study, 70 hemodialysis patients with thrombotic occlusion of double lumen cuffed catheter were studied. Demographic data, underlying disease, dialysis center, catheter size and location, duration of occlusion, history of catheter infection were collected. Blood sample was taken to determine neutralizing antibody before streptokinase injection. Streptokinase (50000 units per ml) was injected to the catheter lumen and was drawn after 24 hours. In order to occlusion documentation, ca radiography of chest and a radiography with contrast was taken before and after streptokinase prescription.Findings: The mean duration of obstruction was 4.4 ± 4.5 days. Neutralizing antibody was positive in 19 (37%) patients. Occlusion was resolved in 63 (90%) patients after streptokinase injection. There was no difference between patients with and without neutralizing antibody in response to Streptokinase (P = 0.324). It was no relation between antibody positivity, infection history, duration of obstruction and response to Streptokinase.  Conclusion: Streptokinase is an effective thrombolytic drug for management of double lumen cuffed catheter obstruction. Presence of neutralizing antibody has no effect on response to Streptokinase. 

Keywords

References

  1. Hohage H, Schulte B, Mehrens T, Kalvaram CM, Pfeiff B, Pullmann H. Serum antibody titers in a systemic lytic therapy with streptokinase. South Med J 1998; 91(11): 1019-23.
  2. Kazmi KA, Perwaiz IM, Rahbar A, Mehboobali N. Anti-streptokinase titers and response to streptokinase treatment in Pakistani patients. Int J Cardiol 2002; 82(3): 247-51.
  3. KDOQI Guidelines. Clinical Practice Guidelines for Hemodialysis Adequacy, Update 2006. American Journal of Kidney Disease 2006; 48(suppl 1): S1-S322.
  4. Allo M, Work J. Venous catheter for hemodialysis. In: Daugirdas JT, Blake PG, Ing TS, editors. Handbook of Hemodialysis. 5th ed. Philadelphia: Wolter Kluwer Company; 2007. p. 87-104.
  5. Brugemann J, van der Meer J, Bom VJ, van der Schaaf W, de Graeff PA, Lie KI. Anti-streptokinase antibodies inhibit fibrinolytic effects of anistreplase in acute myocardial infarction. Am J Cardiol 1993; 72(5): 462-4.
  6. Clase CM, Crowther MA, Ingram AJ, Cina CS. Thrombolysis for restoration of patency to haemodialysis central venous catheters: a systematic review. J Thromb Thrombolysis 2001; 11(2): 127-36.
  7. Goldman L, Bennett C. Text book of Medicine. 21st ed. Philadelphia: Saunders; 1999. p. 304-19.
  8. Shaila G, Chandrashekhar YS, Kumar N, Ganguly NK, Anand IS. Antistreptokinase antibodies before and after streptokinase therapy in patients with acute myocardial infarction from areas endemic for streptococcal infection and influence on reperfusion rates. Am J Cardiol 1994; 74(2): 187-9.
  9. James DCO. Antistreptokinase levels in various hospital patients groups. Postgrad Med J 1973; 49 (suppl): 26-9.
  10. Juhlin P, Bostrom PA, Torp A, Bredberg A. Streptokinase antibodies inhibit reperfusion during thrombolytic therapy with streptokinase in acute myocardial infarction. J Intern Med 1999; 245(5): 483-8.
  11. Bux M, Rodrigues E, Brown A. Antibody response to topical streptokinase. J Wound Care 1997; 6(2): 70-3.
  12. Lew AS, Neer T, Rodriguez L, Geft IL, Shah PK, Ganz W. Clinical failure of streptokinase due to an unsuspected high titer of antistreptokinase antibody. J Am Coll Cardiol 1984; 4(1): 183-5.
  13. Ross P, Jr., Ehrenkranz R, Kleinman CS, Seashore JH. Thrombus associated with central venous catheters in infants and children. J Pediatr Surg 1989; 24(3): 253-6.
  14. McFarland HF, Dinwiddie L, Ferrell J, Forloines-Lynn S. Lytic therapy in central venous catheters for hemodialysis. Nephrol Nurs J 2002; 29(4): 355-60.
Journal of Isfahan Medical School
Volume 29, Issue 149 - Serial Number 149
July and August 2011
Pages 1014-1020

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History

  • Receive Date: 14 March 2011
  • Revise Date:
  • Accept Date: 06 April 2022

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