A 58-year-old man received streptokinase for acute myocardial infarction eight months ago. He now presents with another STEMI within the reperfusion window. Which thrombolytic is contraindicated in him?
- A Alteplase
- B Tenecteplase
- C Streptokinase ✓
- D Reteplase
Correct answer: C. Streptokinase
Explanation
Streptokinase is a bacterial (streptococcal) protein and is highly antigenic. Antistreptococcal antibodies develop after exposure and persist for months to years, so readministration between six months and several years risks both loss of efficacy from antibody neutralisation and severe allergic reactions including anaphylaxis. Alteplase, tenecteplase and reteplase are human tissue plasminogen activator variants, are non-antigenic, and remain fully usable after prior streptokinase.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.