Effect of Streptokinase on Liver Function in Patients with Acute Myocardial Infarction

Streptokinase (SK) is used for thrombolytic therapy in patients with acute myocardial infarction (AMI) who have no contraindication to this drug. SK is the only thrombolytic agent currently available in Iran. Several side effects have been reported for SK, but there is not enough information on its effects on the liver function. There are only a few case reports of icterus and spontaneous liver rupture after SK therapy. Therefore this study was designed to evaluate the SK effects on liver function in patients with AMI. In this clinical trial we selected 68 patients (42 males, and 26 females with mean age of 56 ± 8 years) with AMI that were admitted to the CCU ward. 45 patients who had indication for SK therapy (SK group) received infusion of 1500000 U of SK during 1 hour and 23 patients with AMI that had contraindication for SK therapy in the control group did not receive this treatment. These two groups were matched for age, sex and drug prescription. In all of the patients, liver enzymes, (AST and ALT), bilirubin (direct and total) and alkaline phosphatase were measurad at admission, and 2, 7 and 30 days after that. Exclusion criterias were: history of liver disease, cardiogenic shock, heart failure, ages over 75 years and history of cerebrovascalur accident during the last 6 months. Significant P value was considered as p<0.05. In the SK group 46.6% and in the control group 8.7% had elevated liver transaminases more than two folds of the normal level. 33.3% in the SK group versus 4.3% in the control group had elevated liver enzymes more than 3 folds of the baseline values on admission. These differences were significant by fisher exact test (P= 0.0071). We concluded that thrombolytic therapy with SK causes acute impairment of hepatic function without icterus and commonly seen elevated liver enzyme about 2-3 times of the normal levels.