What is the Difference Between Streptokinase and Alteplase

The key difference between Streptokinase and Alteplase is that Streptokinase is a naturally accruing protein that is isolated from Streptococcus bacteria, while Alteplase is a recombinant human tissue plasminogen activator produced by genetic engineering to treat various conditions such as myocardial infarction, ischemic stroke, and pulmonary emboli.

Streptokinase and Alteplase are thrombolytic medications that are used to break down clots in the blood vessels. They effectively treat various conditions, such as myocardial infarction, ischemic stroke, and pulmonary emboli. Both drugs activate plasminogen to plasmin, which breaks down the fibrin, the main component of blood clots. Streptokinase is usually given as an infusion over 30-60 minutes, while, Alteplase is given as a single injection. The choice of medication depends on several factors, including age, medical history, and the severity of the condition. Alteplase is generally preferred over Streptokinase for treating heart attacks and strokes. However, Streptokinase may be used in patients allergic to Alteplase or with other medical conditions that make them more likely to bleed.

CONTENTS

1. Overview and Key Difference
2. What is Streptokinase
3. What is Alteplase
4. Similarities – Streptokinase and Alteplase
5. Streptokinase vs Alteplase in Tabular Form
6. Summary –  Streptokinase vs Alteplase

What is Streptokinase?

Streptokinase is a purified and sterilized fibrinolytic bacterial protein produced from Streptococcus bacteria. It is a thrombolytic medication that breaks down blood clots in blood vessels. Therefore, Streptokinase treats acute myocardial infarctions, pulmonary embolism, deep vein thrombosis, and arteriovenous cannula occlusion. The drug is given intravenously immediately after the onset of symptoms of a heart attack or other clotting-related conditions. Streptokinase is generally considered a safe and effective medication; however, possible side effects may include bleeding, allergy reactions, low blood pressure, fever, and headache.

Streptokinase forms a particular 1:1 enzymatic complex with plasminogen to cleave the Arg/Val bond in the plasminogen from proteolytic enzyme plasmin. Plasminogen is an inactive molecule, while plasmin degrades the fibrin matrix of the thrombus to exert thrombolytic action. Streptokinase is not recommended for people who have suffered from a recent stroke, surgery, or head injury. It is also not recommended for pregnant and breastfeeding patients.

What is Alteplase?

Alteplase is a recombinant human tissue plasminogen activator used to treat the breakdown clots in blood vessels. It is commonly used to treat myocardial infarction, ischemic stroke, and pulmonary emboli. Alteplase converts plasminogen to plasmin in a fibrin-dependent manner. Alteplase has a higher affinity with fibrin through the lysine residues, allowing the drug to act in a clot-specific manner. In the absence of fibrin, Alteplase converts a limited amount of plasminogen. In contrast, Alteplase converts plasminogen into its active form more rapidly in the presence of fibrin clots. Plasmin, in turn, degrades the fibrin matrix and promotes clot dissolution, suggesting that Alteplase initiates local fibrinolysis with limited systemic proteolysis.

Alteplase is also administered intravenously and reaches the peak plasma concentration 2 minutes after the injections. The drug is mainly metabolized in the liver by following the zero-order kinetics. Then the metabolized drug is mainly excreted by urine with a half-life of less than 5 minutes in patients with acute myocardial infarctions.

What are the Similarities Between Streptokinase and Alteplase?

• Streptokinase and Alteplase primarily treat myocardial infarction, ischemic stroke, and pulmonary emboli.
• They are effective in dissolving clots and improving patient outcomes.
• Both are given as intravenous injections.
• They can cause common side effects such as bleeding, allergic reactions, and low blood pressure.

What is the Difference Between Streptokinase and Alteplase?

Streptokinase and Alteplase are two common drugs used to treat heart attacks, strokes, and pulmonary embolisms by activating plasminogen to plasmin. However, there is a distinct difference between Streptokinase and Alteplase. Streptokinase is a naturally occurring protein isolated from Streptococcus bacteria. In contrast, Alteplase is a recombinant form of human tissue plasminogen activator produced by genetic engineering. Alteplase is more fibrin-specific than Streptokinase, suggesting that it targets explicitly plasminogen in the clots over the plasminogen in the blood, thereby lowering the bleeding complications.

Streptokinase is given after the onset of symptoms, while Alteplase can be given earlier than Streptokinase. In addition, Streptokinase is less expensive and less effective, while Alteplase is more expensive and more effective in dissolving clots and improving patient outcomes.

Below is a summary of the difference between Streptokinase and Alteplase in tabular form for side-by-side comparison.

Summary – Streptokinase vs Alteplase

Streptokinase and Alteplase are two different thrombolytics that dissolve blood clots to prevent heart attacks, strokes, and pulmonary embolisms. These two drugs mediate the thrombolytic effect by converting the inactive plasminogen to active plasmin. However, there is a distinct difference between Streptokinase and Alteplase. Streptokinase is a naturally occurring protein isolated from Streptococcus bacteria, while Alteplase is a recombinant human tissue plasminogen activator produced by genetic engineering. Streptokinase is administered as an intravenous infusion over 30-60 minutes. In contrast, Alteplase is administered as a single intravenous injection. Furthermore, Streptokinase is more likely to cause these side effects. Streptokinase is generally less expensive and less effective, while Alteplase is more expensive and effective. Therefore, Alteplase is preferred over Streptokinase for treating heart attacks and strokes. However, Streptokinase may be used in patients who are allergic to Alteplase or have other medical conditions that make them more likely to bleed.

Reference:

1. Banerjee, Anirban, et al. “Streptokinase—a Clinically Useful Thrombolytic Agent.” Biotechnology Advances, vol. 22, no. 4, 2004, pp. 287–307.
2. Hacke, Werner, et al. “Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke.” New England Journal of Medicine, vol. 359, no. 13, 2008, pp. 1317–1329.

Image Courtesy:

1. “Sk surface 3” By Clossey – Own work (Public Domain) via Commons Wikimedia