Pathophysiology of streptokinase-induced hypotension in acute myocardial infarction: a systematic review of clinical evidence

Introduction: Despite the common occurrence of streptokinase-induced hy- potension among patients with acute myocardial infarction, the underlying pathophysiology remains obscure and poorly understood. Our study aimed to pool clinical evidence on the potential mechanism of streptokinase-in- duced hypotension through a systematic review of the literature. Material and methods: We conducted literature search from Medline, Sco- pus and Web of Science on clinical studies related to streptokinase-induced hypotension. Results: Our search yielded 972 citations. After removal of duplicates, 878 ar- ticles were screened for eligibility, of which 856 papers were excluded due to various reasons. Of the remaining 22 articles retrieved with full texts, eight relevant articles were selected for final analysis. Three themes emerged as the proposed mechanisms of streptokinase-induced hypotension, including (i) reduction in total peripheral resistance, (ii) complement activation, and (iii) dismissal of hypotheses involving other intermediaries. Conclusions: Our findings suggest that the underlying mechanism of strep- tokinase-induced hypotension lies primarily in the reduction in total periph- eral resistance