A Comparative Study of the Safety and Efficacy of Intrapleural Fibrinolysis With Streptokinase and Urokinase in the Management of Loculated Pleural Effusions

Abstract

BackgroundIntrapleural fibrinolytic therapy (IPFT) with streptokinase (STK), urokinase (UK), and alteplase remains a common practice for managing loculated pleural effusions (LPEs). However, very limited data are available on the comparative efficacy of these agents. MethodologyWe compared the efficacy and safety of intrapleural streptokinase (n = 28) and urokinase (n = 38) in 66 patients with loculated effusions. IPFT was initiated if effusion remained undrained despite the placement of intercostal chest drainage or pigtail catheter. The dose of STK and UK were 250,000 IU twice daily and 100,000 IU once daily, respectively. The volume of fluid drained after IPFT, radiologic response, clinical response, and adverse events were compared between the two groups. ResultsThe mean volume of fluid drained post-IPFT was 1,379 mL in the STK arm and 1,110 mL in the UK arm (p = 0.251). Of the 66 patients, 53 (80.3%) had good clinical response, and 28 (43.7%) had >75% resolution of effusion on chest radiographs. The clinical (79% vs. 82%; p = 0.765) and radiologic response rates (39.3% vs. 44.6%; p = 0.568) were similar in both STK and UK arms. Pain was the most common adverse event in both groups. Significantly more patients in the STK arm developed fever (14% vs. 0%, p = 0.030). Treatmentlimiting adverse events occurred in five patients. ConclusionsIPFT is a safe and effective method for managing patients with LPEs. Although the clinical and radiologic response rates were similar with STK and UK, the latter may be the preferred choice because of its better safety profile and ease of administration (once-daily dose).

Intrapleural Streptokinase in Complicated Parapneumonic Effusions and Empyema

“…We made an effort to gather more information about the effectiveness and safety of injecting fibrinolytics intrapleurally to treat such situations. Patients ranged in age from 20 to 65 (mean 45.53 years), and the vast majority were men (n=26, 86.7%), which is in line with recent research that showed a preponderance of males (8)(9)(10)(11) . This might be because men engage in more outdoor activities, making them more vulnerable to trauma and infections.…”

“…Our investigation found a significant rise in the mean drainage volume between the time before and after streptokinase injection (from 314±70.8 mL to 878±168.6 mL respectively). Saxena and Maturu (11) discovered that the average amount of fluid drained by using the streptokinase was 1,379.23± 771.9 mL. Also, Bouros et al (15) , reported that the total amount of fluid evacuated following therapy for streptokinase was 1,596±68 mL, which is higher than our statement.…”

“…In the study by Reza et al (10) , the most common complaints were fever (81%), cough (72%), shortness of breath (66%), chest discomfort (59%), and appetite loss (34%). According to a recent study by Saxena and Maturu (11) , the most prevalent symptoms included fever (68.2%), cough (77.3%), dyspnea (89.4%), loss of appetite (57.6%), weight loss (54.5%), and chest pain (36.4%).…”

“…6 of the 13 patients who did not react to treatment needed additional treatments, including thoracoscopic adhesive lysis (n=3), surgical decortication (n=2), and relocation of the pigtail catheter (n=1). It is difficult to pinpoint the exact cause of success variability, but it may be related to a variety of things, including case selection, experience, and techniques of results evaluation (11) .…”

“…In addition to chest tube drainage, several studies found that intrapleural streptokinase decreased the requirement for surgery and increased the clinical treatment success in patients with PPE/empyema (6)(7)(8)(9)(10)(11) .…”