In acute myocardial infarction they are of most value when used within 12h of the onset. They may require adjuvant therapy (e.g. aspirin with streptokinase or heparin with rt-PA) to maximise the effect in acute myocardial infarction.

rt-PA is said to be clot selective and is therefore useful where a need for invasive procedures has been identified.

Anaphylactoid reactions to streptokinase are not uncommon, particularly in those who have had streptococcal infections, and patients should not be exposed twice between 5 days and 1 year of receiving the last dose.

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