Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project

Popowicz, Natalia; Bintcliffe, Oliver; Fonseka, Duneesha de; Blyth, Kevin G.; Smith, Nicola; Piccolo, Francesco Lo; Martin, Geoffrey; Wong, Donny; Edey, Anthony; Maskell, Nick A; Lee, Gary

doi:10.1513/annalsats.201609-673oc

Cited by 83 publications

(76 citation statements)

References 23 publications

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“…This regime is yet to be tested in larger RCT’s. Despite a similar bleeding incidence, of approximately 6%, such a regime may help alleviate some of the anxiety surrounding the use of IPFT as well as making it more cost‐effective. A small prospective observational study of 38 patients looked to simplify the regime comparing concurrent vs. sequential intrapleural instillation of tPA and DNase, removing the 1 hr interval between each administration, and reported similar treatment success .…”

Section: Treatmentmentioning

confidence: 99%

Recent developments in the management of pleural infection: A comprehensive review

Bedawi

Hassan

Rahman

2018

Clinical Respiratory J

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Section: Treatmentmentioning

confidence: 99%

Recent developments in the management of pleural infection: A comprehensive review

Bedawi

Hassan

Rahman

2018

Clinical Respiratory J

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“…Heterogeneity is therefore common in clinical practice. Interestingly, there is increasing evidence to support the use of lower doses of tPA (with deoxyribonuclease (DNase)) as intrapleural therapy for pleural infections . A prior case report has described the successful use of tPA doses as low as 1 mg, together with 5 mg DNase, in the setting of pleural infection in a patient with high bleeding risks .…”

Section: Discussionmentioning

confidence: 99%

Very low‐dose intrapleural tPA for indwelling pleural catheter‐associated symptomatic fluid loculation

Lan

Vekaria

Sidhu

et al. 2019

Respirology Case Reports

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Indwelling pleural catheters (IPCs) are effective management options for malignant pleural effusion. Symptomatic fluid loculation is a recognized complication of IPC use and is usually managed with intrapleural instillation of fibrinolytic drugs, such as tissue plasminogen activator (tPA). A previous multicentre observational study showed significant heterogeneity among centres in their dosing regimen for tPA (from 2 to 20 mg) in treating symptomatic loculations. Potential pleural bleeding, especially in high‐risk patients, often deters clinicians from initiating intrapleural fibrinolytic therapy. Lower doses of tPA may reduce bleeding risks. This case report describes the successful use of 0.5 mg (the lowest reported dose) of tPA in a patient with significant bleeding risks whose IPC was complicated by symptomatic loculation.

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“…The bleeding risk and costs associated with tPA remain clinicians’ major concerns. Recent dose de‐escalation studies found a similar success rate using 5 mg of tPA and further studies using 2.5 mg are underway .…”

Section: Introductionmentioning

confidence: 89%

Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime

Hart

Badiei

Lee

2019

Respirology Case Reports

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Pleural infection managed with intrapleural therapy using a combination of 10 mg of tissue plasminogen activator (tPA) and 5 mg of deoxyribonuclease (DNase) has been shown in randomized and open‐label studies to successfully treat >90% of patients without resorting to surgery. Potential bleeding risks, although low, and costs associated with tPA remain important concerns. No phase I studies exist for intrapleural tPA therapy and the lowest effective dose has not been established. In patients with high bleeding risks, lower doses may present a safer alternative. We report a case of a complex parapneumonic effusion in a patient with coagulopathy that was successfully treated with a very low dose tPA (1 mg) and DNase (5 mg) regime.

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Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project

Abstract: There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/154169/ Conflict of Interests:YCGL is a member of the advisory board for Lung Therapeutics Inc.

Cited by 83 publications

References 23 publications

Recent developments in the management of pleural infection: A comprehensive review

Recent developments in the management of pleural infection: A comprehensive review

Very low‐dose intrapleural tPA for indwelling pleural catheter‐associated symptomatic fluid loculation

Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime

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