A patient with STEMI is given streptokinase. After 3 hours, re-occlusion occurs and fibrinolytic therapy is needed again. Streptokinase is NOT repeated. The MOST appropriate fibrinolytic to use now is:
- A Alteplase ✓
- B Urokinase
- C Streptokinase again at double dose
- D Ancrod
Correct answer: A. Alteplase
Explanation
Streptokinase is a bacterial protein that induces antibody formation within 5 days; these antibodies persist for years and neutralise any subsequent dose of streptokinase or anistreplase. Alteplase (recombinant t-PA) is non-antigenic and unaffected by streptokinase antibodies, making it the correct choice for repeat fibrinolysis. Urokinase is also non-antigenic but is not the first-line agent for STEMI.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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