Failure of Talc Pleurodesis Is Associated with Increased Pleural Fibrinolysis

Rodríguez-Panadero, Francisco; Segado, A.; Juan, José Martín; Ayerbe, R; Garcia, Ismael; Castillo, J

doi:10.1164/ajrccm/151.3_pt_1.785

Cited by 64 publications

(9 citation statements)

References 18 publications

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“…Demonstration of failed talc pleurodesis was associated with increased pleural fibrinolysis [12]. Therefore, in the presence of diclofenac, both reduced levels of TGF-β and increased levels of fibrinolysis factor D-dimer and human tPA in the pleural fluid may explain the reduced effect on pleurodesis described 3 weeks after thoracoscopic pleural abrasion [1].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Diclofenac Application during Video-Assisted Thoracic Surgery Pleurodesis Modulates Early Inflammatory and Fibrinolytic Processes in an Experimental Model

Opitz¹,

Arni²,

Oberreiter³

et al. 2013

Eur Surg Res

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Background/Purpose: It has been substantiated that the quality of pleurodesis is reduced when non-steroidal anti-inflammatory drugs (NSAIDs) are used perioperatively. The effects of NSAID administration on the early inflammatory and fibrinolytic processes after mechanical pleurodesis were investigated in an established pig model. Methods: Left-sided mechanical pleural abrasion was performed on 24 pigs assigned to either an NSAID or a control group. Pleural fluid and blood samples were analysed over a 24-hour period. Histological evaluation of neutrophil influx at the site of pleural abrasion was performed. Results: The volume of pleural effusion was significantly decreased in the diclofenac group at 10 and 24 h, and the protein content was significantly lower. The diclofenac group at 24 h had a diminished total number of white blood cells and a reduced content of transforming growth factor-β. Moreover, the diclofenac group had a reduced percentage of neutrophils at 6 h. Significantly increased levels of D-dimers and tissue plasminogen activator were measured at 6 h and of interleukin-10 at 24 h. Neutrophils at the site of pleural abrasion were significantly reduced. Conclusions: Systemic application of diclofenac led to a local enhancement of fibrinolysis and attenuation of pro-inflammatory and fibrotic processes necessary for adhesion formation in our model.

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Section: Discussionmentioning

confidence: 99%

Perioperative Diclofenac Application during Video-Assisted Thoracic Surgery Pleurodesis Modulates Early Inflammatory and Fibrinolytic Processes in an Experimental Model

Opitz¹,

Arni²,

Oberreiter³

et al. 2013

Eur Surg Res

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“…Rodriguez-Panadero et al demonstrated that successful pleurodesis was associated with significant reduction of the fibrinolytic activity expressed as pleural fluid D-dimer concentration 1 day after the administration of powdered talc ( p < 0.001). Interestingly, pleural D-dimer level did not decrease in patients with treatment failure [74]. On the contrary, a significant increase in fibrinolysis was observed 3 h after intrapleural talc administration in those patients.…”

Section: Coagulation Cascadementioning

confidence: 99%

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

et al. 2019

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Chemical pleurodesis is a therapeutic procedure applied to create the symphysis between the parietal and visceral pleura by intrapleural administration of various chemical agents (e.g. talk, tetracycline, iodopovidone, etc.). The two major clinical conditions treated with chemical pleurodesis are recurrent pleural effusion (PE) and recurrent spontaneous pneumothorax. Although the history of chemical pleurodesis began over a century ago, detailed data on the mechanisms of action of sclerosing agents are highly incomplete. The following article aims to present the state of knowledge on this subject.It is believed that mesothelial cells are the main structural axis of pleurodesis. In response to sclerosing agents they secrete a variety of mediators including chemokines such as interleukin 8 (IL-8) and monocyte chemoattractant protein (MCP-1), as well as growth factors - vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and transforming growth factor- β (TGF-β). Numerous data suggest that intact mesothelial cells and the above cytokines play a crucial role in the initiation and maintenance of different pathways of pleural inflammation and pleural space obliteration.It seems that the process of pleurodesis is largely nonspecific to the sclerosant and involves the same ultimate pathways including activation of pleural cells, coagulation cascade, fibrin chain formation, fibroblast proliferation and production of collagen and extracellular matrix components. Of these processes, the coagulation cascade with decreased fibrinolytic activity and increased fibrinogenesis probably plays a pivotal role, at least during the early response to sclerosant administration.A better understanding of various pathways involved in pleurodesis may be a prerequisite for more effective and safe use of various sclerosants and for the development of new, perhaps more personalized therapeutic approaches.

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“…In this regard, we hypothesized a few years ago that either an impaired fibrin formation or an increase in endopleural fibrinolysis would lead to pleurodesis failure. Our group demonstrated that failure of talc pleurodesis is associated with an increased pleural fibrinolysis [10]. …”

Section: Mechanisms Involved In Pleurodesismentioning

confidence: 99%

Mechanisms of Pleurodesis

2012

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Pleurodesis aims to obliterate the pleural space by producing extensive adhesion of the visceral and parietal pleura, in order to control relapse of either pleural effusions (mostly malignant) or pneumothorax. A tight and complete apposition between the two pleural layers is a necessary condition to obtain a successful pleurodesis, but – besides this mechanical aspect – there are many biological mechanisms that appear to be common to most of the sclerosing agents currently used. Following intrapleural application of the sclerosing agent, diffuse inflammation, pleural coagulation-fibrinolysis imbalance (favoring the formation of fibrin adhesions), recruitment and subsequent proliferation of fibroblasts, and collagen production are findings in the pleural space. The pleural mesothelial lining is the primary target for the sclerosant and plays a pivotal role in the whole pleurodesis process, including the release of several mediators like interleukin-8, transforming growth factor-β and basic fibroblast growth factor. When the tumor burden is high, normal mesothelial cells are scarce, and consequently the response to the sclerosing agent is decreased, leading to failure of pleurodesis. Also, the type of tumor in the pleural cavity may also affect the outcome of pleurodesis (diffuse malignant mesothelioma and metastatic lung carcinomas have a poorer response). There is general agreement that talc obtains the best results, and there are also preliminary experimental studies suggesting that it can induce apoptosis in tumor cells and inhibit angiogenesis, thus contributing to a better control of the malignant pleural effusion. There is concern about complications (possibly associated with talc but other agents as well) related to systemic inflammation and possible activation of the coagulation cascade. In order to prevent extrapleural talc dissemination, large-particle talc is recommended. Although it could – to some degree – interfere with the mechanisms leading to pleurodesis and a carefully balanced clinical decision has therefore to be made, prophylactic treatment with subcutaneous heparin is recommended during hospitalization (immediately before and after the pleurodesis procedure).

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Failure of Talc Pleurodesis Is Associated with Increased Pleural Fibrinolysis

Cited by 64 publications

References 18 publications

Perioperative Diclofenac Application during Video-Assisted Thoracic Surgery Pleurodesis Modulates Early Inflammatory and Fibrinolytic Processes in an Experimental Model

Perioperative Diclofenac Application during Video-Assisted Thoracic Surgery Pleurodesis Modulates Early Inflammatory and Fibrinolytic Processes in an Experimental Model

Chemical pleurodesis – a review of mechanisms involved in pleural space obliteration

Mechanisms of Pleurodesis

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