The Effect of Streptokinase Neutralizing Antibodies on Thrombolytic Activity in Double Lumen Cuffed Catheter

Streptokinase is the only available thrombolytic agent in some areas. Streptococcal infection induces streptococcal antibodies and these antibodies increase failure rate in response to Streptokinase. This study was designed to investigate the effect of neutralizing antibodies on therapeutic effect of streptokinase to treat lumen cuffed catheter occlusion.

In this study, 70 hemodialysis patients with thrombotic occlusion of double lumen cuffed catheter were studied. Demographic data, underlying disease, dialysis center, catheter size and location, duration of occlusion, history of catheter infection were collected. Blood sample was taken to determine neutralizing antibody before streptokinase injection. Streptokinase (50000 units per ml) was injected to the catheter lumen and was drawn after 24 hours. In order to occlusion documentation, ca radiography of chest and a radiography with contrast was taken before and after streptokinase prescription.

The mean duration of obstruction was 4.4 ± 4.5 days. Neutralizing antibody was positive in 19 (37%) patients. Occlusion was resolved in 63 (90%) patients after streptokinase injection. There was no difference between patients with and without neutralizing antibody in response to Streptokinase (P = 0.324). It was no relation between antibody positivity, infection history, duration of obstruction and response to Streptokinase.

Streptokinase is an effective thrombolytic drug for management of double lumen cuffed catheter obstruction. Presence of neutralizing antibody has no effect on response to Streptokinase.