Outcomes and Safety of Half-Dose Streptokinase in Elderly Patients With ST-Segment Elevation Myocardial Infarction in the Sisaket Provincial STEMI Network: A Retrospective Cohort Study
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Abstract
Introduction: In elderly patients with ST-segment Elevation Myocardial Infarction (STEMI), standard-dose Streptokinase (SK) (1,500,000 units) is associated with an increased risk of intracranial hemorrhage. Half-dose SK (750,000 units) has been implemented to improve safety; however, comparative data in the Thai clinical context remain limited.
Objectives: To compare the clinical outcomes, efficacy, and safety of half-dose versus standard-dose Streptokinase in elderly patients with STEMI at Sisaket Hospital.
Methods: This retrospective descriptive study evaluated patients aged ≥70 years with STEMI who received SK from October 2023 to August 2025. The primary outcome was the reperfusion success rate at 60 minutes post-administration. Secondary outcomes included major bleeding and in-hospital mortality. Propensity Score Matching (PSM) was utilized to adjust for potential confounders.
Results: Of the 98 included patients, 37% received half-dose SK. After PSM analysis, the half-dose group demonstrated a higher reperfusion success rate compared to the standard-dose group (62.9% vs. 54.3%; p = 0.467). Regarding safety, major bleeding occurred in 8.3% of the half-dose group and 0% of the standard-dose group (p = 0.239). SK-induced hypotension was less frequent in the half-dose group (27.8% vs. 50.0%; p = 0.053). No statistically significant differences were observed across all clinical parameters.
Conclusion: There were no significant differences in efficacy or safety between half-dose and standard-dose SK in elderly STEMI patients at Sisaket Hospital. Half-dose SK appears to be a viable therapeutic alternative with comparable clinical outcomes.
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