Raised levels of antistreptokinase antibody and neutralization titres from 4 days to 54 months after administration of streptokinase or anistreplase

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Abstract
Streptokinase and anistreplase are antigenic and their administration often leads to antibody formation. These can cause allergic reactions and/or neutralization of streptokinase with resulting suboptimal treatment. Currently, streptokinase re-administration is considered appropriate for up to 5 days and from 1 year after a previous dose. Antistreptokinase antibody and neutralization titres (NT) were measured in three groups of patients to determine if this practice is appropriate: 1. (early)—36 patients whose titres were measured for at least 5 days after thrombolysis; 2. (late)—57 patients who received thrombolysis 12–54 months previously; 3. (controls)—182 consecutive suspected myocardial infarction patients (without previous exposure to thrombolysis). Results were as follows (mean±SEM): 1. (early)—the antibody and/or NT were raised by day 4 in 19.4% of the patients. One patient could have neutralized 1.97 million units (MU) of streptokinase by day 4. (Day 4—antibody 1:39±11, NT 0.19±0.05 MU; day 5–1:136±41 and NT 0.7±0.43 MU respectively.) 2. (late)—23 patients (40%) had either antibody titres ≥ 1:160 and/or NT> 1.5 MU. (12–23 months—antibody 1:243±43, NT 0.63±0.15 MU; 24–35 months—1:98±31 and 0.69±0.22 MU; 36–54 months—1:87±14 and 0.54±0.12 MU.) All titres were significantly higher than the controls (antibody 1:25±3. NT 0.14±0.01 MU, P<0.01). After streptokinase or antistreplase, antibodies are raised from 4 days to at least 54 months. It would seem prudent to avoid their re-administration during this time interval.

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