Alteplase and Streptokinase Stability

Our nephrologists wants to  use injection streptokinase to restore patency to thrombosed hemodialysis catheter and they dilute one vial of 75000 iu in 100 ml normal saline or water for injection then use 3 ml only and the remaining is discarded.

In our hospital we prepare ALTEPLASE in conc of 2mg/2ml stored in freezer to clear occluded venous catheter, which is stable for 6 months.

A regimen of alteplase is safe and effective for restoring flow to occluded central venous access devices compared to streptokinase because of the risk of life-threatening anaphylaxis.

Regarding streptokinase stability:

• Stability was found to be (8) hours in room temperature do to risk of contamination.
• Stability was found to be (24) hours in refrigerator.

Personally, I prefer the use of Alteplase over Streptokinase for the following reasons:

1. Stability of reconstituted Alteplase  at concentration of (1mg/ml) in SWFI then frozen at (-20 C) is (6 months in polypropylene syringes) and (32 days in glass vials). 
2. Lower risk of complications than streptokinase.