K. Al Shwafi et al., Rapid detection of streptokinase resistance using a bedside lytic assay ofdry reagent technology, FIBRINOL PR, 14(6), 2000, pp. 351-357
A new bedside lytic assay using dry reagent technology for rapid (3-5 min)
detection of streptokinase resistance (SKR) was recently introduced, which
measures lysis onset time (LOT) of whole blood clot in response to high and
low streptokinase (SK) concentrations: 100 U/ml (SK100) and 10 U/ml (SK10)
. SKR was defined by prolongation of LOT, previously correlated with the st
andard SK Reactivity Test and with clinical outcome of acute myocardial inf
arction (AMI) SK-treated patients, high SKR when SK100>50 seconds and SK10>
120 seconds; partial SKR when SK10>120 seconds. Five prospective clinical g
roups (325 patients) were screened in cardiac units of four university hosp
itals, In patients previously treated with SK, the prevalence of SKR was 87
% (70% high, 17% partial); in those who had documented streptococcal infect
ion, 92% (75% high, 17% partial); and in patients with rheumatic heart dise
ase, 76% (all high). SKR prevalence was 55% (33% high, 22% partial) in thos
e with recent respiratory tract infection. In 225 acute coronary patients,
SKR was 28% (21% high, 7% partial), and was identical by gender, but was 36
% (32% high, 4% partial) in patients greater than or equal to 65 years Vers
us 19% (9% high, 10% partial) in those < 65 years (P < 0.0001).
In conclusion, we demonstrated (with a rapid functional assay) the consiste
nce of our results with the expected prevalence of SKR in the groups studie
d, this points out to the feasibility of pre-therapeutic detection of SKR a
nd choice between t-PA and SK made at bedside without delaying the onset of
treatment. As SKR is common among candidates for thrombolysis, pre-therape
utic detection of SKR merits further investigation. (C) 2000 Harcourt Publi
shers Ltd.