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VOLUME 58 , ISSUE 1 ( January-March, 2016 ) > List of Articles

Original Article

A Five-Year Study of Intrapleural Fibrinolytic Therapy in Loculated Pleural Collections

M.S. Barthwal, V. Marwah, M. Chopra, Y. Garg, R. Tyagi, K. Kishore, A. Vijay, V. Dutta, C.D.S. Katoch, S. Singh, D. Bhattacharya

Keywords : Loculated effusions, Complicated parapneumonic effusions, Intrapleural fibrinolytic therapy

Citation Information : Barthwal M, Marwah V, Chopra M, Garg Y, Tyagi R, Kishore K, Vijay A, Dutta V, Katoch C, Singh S, Bhattacharya D. A Five-Year Study of Intrapleural Fibrinolytic Therapy in Loculated Pleural Collections. Indian J Chest Dis Allied Sci 2016; 58 (1):17-20.

DOI: 10.5005/ijcdas-58-1-17

License: CC BY-NC 4.0

Published Online: 17-11-2022

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Background: Pleural fluid loculations due to complicated parapneumonic effusion (CPE), empyema, tubercular effusion and traumatic hemothorax can be managed either by video-assisted thoracoscopic surgery (VATS) or intrapleural fibrinolytic therapy (IPFT). The former is more invasive, not easily available and is also more expensive. On the other hand, IPFT is less invasive, cheaper, easily accessible and if used early, in loculated pleural collections, break loculations and early pleural peel, thereby facilitating pleural space drainage. Objective: To study the efficacy of IPFT in facilitating pleural space drainage in loculated pleural collections of diverse aetiologies. Methods: A five-year retrospective, observational study of 200 patients, with loculated pleural collections and failed tube drainage and managed with IPFT was carried out. Responders were defined as those with significant volume of fluid drained and significant radiological resolution. Results: There were 106 (53%) cases of CPE, 59 (29.5%) cases of tubercular effusion, 23 (11.5%) cases of empyema and 12 (6%) cases of hemothorax. Responders were 148 (74%) in number. The distribution of responders as per type of loculated pleural collection was as follows: CPE 88 (83%), tubercular 37 (62.7%), empyema 14 (60.8%) and traumatic hemothorax 11 (91.6%). The adverse effects were mild and included chest pain in six patients and low-grade transient fewer in three cases. Conclusions: Intrapleural fibrinolytic therapy is a safe and cost-effective option in the management of selected patients with loculated pleural effusions.

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  1. Boland GW, Lee MJ, Silverman S, Mueller PR. Interventional radiology of the pleural space. Clin Radiol 1995;50:205–14.
  2. Simpson G, Roomes D, Heron M. Effects of streptokinase and deoxyribonuclease on viscosity of human surgical andempyema pus. Chest 2000;117:1728–33.
  3. Light RW, Nguyen T, Mulligan ME, Sasse SA. The in vitro efficacy of varidase versus streptokinase or urokinase forliquefying thick purulent exudative material from loculated empyema. Lung 2000;178:13–8.
  4. Barthwal MS, Deoskar RB, Rajan KE, Chatterjee RS. Intrapleural streptokinase in complicated parapneumonic effusions and empyema. Indian J Chest Dis Allied Sci 2004;46:7251–61.
  5. Jerjes-Sanchez C, Ramirez-Rivera A, ElizaldeJJ, Delgado R, Cicero R, Ibarra-Perez C, et al. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial. Chest 1996;109:1514–9.
  6. Sherry S, Johnson A, Tillett WS. The action of streptococcal desoxyribose nuclease (streptodornase) in vitro, and on purulent pleural exudations of patients. J Clin Invest 1949;28:1094–104.
  7. Tillett WS, Sherry S, Christensen LR, Johnson AJ, Hazlehurst G. Streptococcal enzymatic debridement. Ann Surg 1956;131:12–22.
  8. Tillett WS, Sherry S, Read CT. The use of streptokinasestreptodornase in the treatment of post pneumonic empyema. J Thorac Surg 1951;21:275–97.
  9. Bergh NP, Ekroth R, Larsson S, Nagy P. Intrapleural streptokinase in the treatment of hemothorax and empyema. Scand J Thorac Cardiovasc Surg 1977;11:265–8.
  10. Sahn SA. Use of fibrinolytic agents in the management of complicated parapneumonic effusions and empyemas. Thorax 1998;53 (Suppl. 2): s56–72.
  11. Davies RJ, Tarill ZC, Gleeson FV. Randomized controlled trial of intrapleural streptokinase in community acquired pleural infections. Thorax 1997;52:416–21.
  12. Bourous D, Schiza S, Tzanakis N, Chalkiadakis G, Drositis J, Siafakas N. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema: a randomized, double-blind study. Am J Respir Crit Care Med 1999;159:37–42.
  13. Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions. Chest 1997;111:275–9.
  14. Tuncozgur B, Ustunsoy H, Sivrikoz MC, Dikensoy O, Topal M, Sanli M, et al. Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial. Int J Clin Pract 2001;55:658–60.
  15. Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bolliger CT. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Care Med 2004;170:49–53.
  16. Sharma VP, Guleria R, Gupta R, Sharma SK, Pande JN. Intrapleural streptokinase in multiloculated empyema thoracis. J Assoc Physicians India 1998;46:227–9.
  17. Barthwal MS. Intrapleural streptokinase in complicated parapneumonic effusion: a case report. J Assoc Physicians India 1998;46:907–8.
  18. Talib SH, Verma GR, Arshad M, Tayade BO, Rafeeque A. Utility of intrapleural streptokinase in management of chronic empyemas. J Assoc Physicians India 2003;51:464–8.
  19. Banga A, Khilnani GC, Sharma SK, Dey AB, Wig N, Banga N. A study of empyema thoracis and role of intrapleural streptokinase in its management. BMC Infect Dis 2004;4:19.
  20. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. First Multicenter Intrapleural Sepsis Trial (MISTI) Group, UK. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865–74.
  21. Barthwal MS. Intrapleural streptokinase in a two-year-old child with parapneumonic effusion. Indian J Chest Dis Allied Sci 2001;43:165–8.
  22. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM. A randomized trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343–7.
  23. Hunt I, Thakar C, Southon R, Bédard EL. Establishing a role for intra-pleural fibrinolysis in managing traumatic haemothoraces. Interact Cardiovasc Thorac Surg 2009;8:129– 33.
  24. Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. April 16 2008;CD 002312.
  25. Janda S, Swiston J. Intapleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis. Chest 2012;142:401– 11.
  26. Inci I, Ozcelik C, Ulkii R, Tuna A, Eren N. Intrapleural fibrinolytic treatment of traumatic clotted hemothorax. Chest 1998;1:160–5.
  27. Jerjes-Sánchez C, Ramirez-Rivera A, Elizalde JJ, Delgado R, Cicero R, Ibarra-Perez C, et al. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial. Chest 1996;109:1514–9.
  28. Kimbrell BJ, Yamzon J, Petrone P, Asensio JA, Velmahos GC. Intrapleural thrombolysis for the management of undrained traumatic hemothorax: a prospective observational study. J Trauma 2007;62:1175–8.
  29. Aye RW, Froese DP, Hill LD. Use of purified streptokinase in empyema and hemothorax. Am J Surg 1991;161:560–2.
  30. Strange C, Baumann MH, Sahn SA, Idell S. Effects of intrapleural heparin or urokinase on the extent of tetracycline induced pleural disease. Am J Respir Crit Care Med 1995;151:508–15.
  31. Bouros D, Schiza S, Tzanakis N, Chalkiadakis G, Drositis J, Siafakas N. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema: a randomised double blind study. Am J Respir Crit Care Med 1999;159:37–42
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