Chest
Clinical Investigations: The PleuraIntrapleural Fibrinolysis With Streptokinase as an Adjunctive Treatment in Hemothorax and Empyema: A Multicenter Trial
Section snippets
Primary End Point
To evaluate the role of intrapleural fibrinolysis in clotted or loculated pleural collections, and to investigate if major surgical procedures can be avoided, a prospective, open, and multicenter trial was carried out in five hospitals in Mexico.
Inclusion and Exclusion Criteria
Patients were included if they had clotted hemothorax or loculated empyema, or malignant loculated pleural effusion without lung trapping that did not resolve after pleural drainage with closed thoracotomy. Patients were also included if they had
RESULTS
From October 1993 to April 1995, 49 consecutive patients were enrolled. One patient with chronic renal failure and empyema was excluded owing to bronchopleural fistula on the second day of IPSK. The remaining 48 patients represent the basis of our report.
Patients' demographic data, etiology, pleural drainage, number of loci, length of treatment, and complications are depicted in Table 1. Regarding pleural space management, in cases of empyema (30/48), diagnosis was supported by aspiration of
DISCUSSION
The results in this multicentric trial suggest that intrapleural fibrinolysis is useful in the treatment of persistent, loculated hemothorax and empyema. A significant increase in the drainage of chest tube and/or loci lysis with improvement from the clinical, radiologic, and pulmonary function point of view was demonstrated early and after approximately 6 months. Administration of IPSK avoided surgical decortication in a significant number of patients as did other aggressive, prolonged, and
CONCLUSION
Our results in this multicenter trial suggest that intrapleural fibrinolysis appears to be an effective and safe adjunctive therapy in patients with heterogeneous pleural proteinaceous retained collections, loci lysis, and can obviate surgery in most cases. Although the standard streptokinase regimen was effective, a new IPSK-controlled, randomized regimen should be tested in other trials.
REFERENCES (15)
- et al.
Use of intrapleural streptokinase in the treatment of thoracic empyema
Am J Med Sci
(1990) - et al.
Use of purified streptokinase in empyema and hemothorax
Am J Surg
(1991) - et al.
Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients
Chest
(1993) - et al.
Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase
Chest
(1995) - et al.
Empyema of the thorax in adults
Chest
(1993) - et al.
Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas
Ann Thorac Surg
(1994) - et al.
Treatment of thoracic multiloculated empyemas with intracavitary urokinase
Radiology
(1991)
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