Intrapleural Tissue Plasminogen Activator for Complicated Pleural Effusions.
Skeete, Dionne A. MD; Rutherford, Edmund J. M; Schlidt, Scott A. MD; Abrams, Jeffrey E. MD; Parker, L A. MD; Rich, Preston B. MD
Journal of Trauma-Injury Infection & Critical Care.
57(6):1178-1183, December 2004.
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Background: This study is aimed at evaluating the safety and efficacy of intrapleural tissue plasminogen activator (TPA) for complicated pleural effusions, including posttraumatic hemothorax.
Methods: Data were retrospectively collected from hospitalized patients over a 4-year period (1999-2003) who were treated with intrapleural TPA after failing drainage by tube thoracostomy. Pre- and post-TPA imaging studies were reviewed and scored by a blinded radiologist.
Results: Forty-one consecutive patients with 42 effusions were identified with the following indications: 6 traumatic hemothoraces (14%), 22 loculated pleural effusions (52%), 2 line-associated hemothoraces (5%), and 12 empyemas (29%). Nine patients (22%) required operative drainage including two with posttraumatic hemothoraces. All patients managed nonoperatively demonstrated radiographic improvement after TPA administration. One patient (2.4%) developed hematuria, requiring transfusion. No trauma patient required TPA-related blood transfusion and no deaths were attributable to TPA therapy.
Conclusion: Intrapleural TPA administration appears safe for use in complicated pleural effusions and may decrease the need for operative intervention.
(C) 2004 Lippincott Williams & Wilkins, Inc.