Hemothorax following Administration of Intrapleural Alteplase

A, Ruiz; Porcel, José M.; Madroñero, Ana Belén; Galindo, Carles

doi:10.1159/000095314

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Ruiz et al . reported massive hemothorax, following intrapleural alteplase for complicated parapneumonic effusion in a 31-year-old woman [ 8 ]. The patient was not reported as being coagulopathic or anticoagulated at the time, was resuscitated, and underwent thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

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Life-threatening pleural hemorrhage following intrapleural enzyme therapy and successful treatment with fibrin-thrombin sealant pleurodesis: a case report

Vun

Lance

2015

J Med Case Reports

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IntroductionIntrapleural fibrinolytic enzyme therapy is a potentially surgery-sparing treatment for poorly resolving parapneumonic effusion and empyema. It is safe in the majority of patients, however the most significant risk associated with this treatment is severe bleeding secondary to pleural hemorrhage. Contraindications for intrapleural enzyme therapy are not widely agreed upon and little is known about how to treat this difficult and potentially lethal hemorrhagic complication.Case presentationAn independent 82-year-old Caucasian man presented to hospital with an empyema complicating community-acquired pneumonia and coincidental pulmonary embolus. He was initially commenced on intravenous antibiotics, pleural drainage and anticoagulation, however failed to improve significantly and was commenced on intrapleural fibrinolytic enzyme therapy. Shortly after, he suffered severe pleural hemorrhage that was uncontrollable despite emergency thoracotomy and washout. Subsequent hemostasis was achieved after re-exploration and application of topical fibrin-thrombin sealant spray. The patient survived and was discharged home.ConclusionsIntrapleural enzyme therapy can be effective in loculated parapneumonic effusion and empyema, but massive pleural hemorrhage can complicate its use. Pleural hemorrhage appears to be associated with anticoagulation or coagulopathy, and can be difficult to manage. This case adds to the body of data on bleeding complications following intrapleural enzyme therapy, and to the best of our knowledge is the first report of fibrin-thrombin sealant use in this setting.

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Section: Discussionmentioning

confidence: 99%

“…No hemorrhage in those receiving prophylactic anticoagulation or clopidogrel Ruiz et al . 2006 [ 8 ] Case report One adult Alteplase Nil Massive pleural hemorrhage DNase deoxyribonuclease, tPA tissue plasminogen activator …”

Section: Case Presentationmentioning

confidence: 99%

Life-threatening pleural hemorrhage following intrapleural enzyme therapy and successful treatment with fibrin-thrombin sealant pleurodesis: a case report

Vun

Lance

2015

J Med Case Reports

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“…Dla zwiększenia efektywności drenażu leki te są nawet niekiedy stosowane u chorych ze świeżym hemothorax [18]. Tym niemniej opisano pojedyncze przypadki krwawienia do opłucnej po doopłucnowym leczeniu fibrynolitycznym [19,20]. W Klinice Chorób Wewnętrznych, Pneumonologii i Alergologii leczenie takie jest stosowane od 15 lat i poza zmianą zabarwienia drenowanego płynu nie stwierdziliśmy dotychczas powikłań krwotocznych w jamie opłucnej.…”

Section: Omówienieunclassified

Hemorrhagic Parapneumonic Effusion in a 64 Year-Old Patient as the First Symptom of Hemophilia B

Grabczak

Krenke²,

Jeleńska³

et al. 2009

Advances in Respiratory Medicine

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Hemophilia B is an inherited, X chromosome-linked disease. It is usually diagnosed in childhood, sometimes in adolescence. The commonest symptoms include spontaneous or post-traumatic bleeding into the joints and/or muscles, as well as mucosal bleeding. Respiratory symptoms are rarely reported. We present the case of a 64 year-old man in whom bloody parapneumonic effusion (hemothorax) was the first symptom of hemophilia B. The reason for prolonged activated partial thromboplastin time (APTT) found on admission has not been elucidated. Since antibiotic therapy and pleural tube thoracostomy with intrapleural streptokinase were found to be ineffective, video-assisted thoracic surgery was performed with the right lung decortication. Post-operative treatment was complicated by massive pleural bleeding requiring two subsequent thoracotomies. Additional blood tests revealed factor IX deficiency and resulted in hemophilia B being diagnosed. The presented case proves that hereditary bleeding disorders may be diagnosed even in late adulthood. Intrapleural bleeding related to pneumonia and pleural inflammation might be the first presenting symptom. Hemophilia should be considered as a potential cause of APTT prolongation, even in an elderly patient with atypical presentation. Explaining the reason for APTT prolongation before the surgical procedure could have allowed to avoid severe bleeding in the described patient.

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Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema

Altmann

Crossingham

Wilson

et al. 2019

Cochrane Database of Systematic Reviews

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Hemothorax following Administration of Intrapleural Alteplase

Cited by 6 publications

References 10 publications

Life-threatening pleural hemorrhage following intrapleural enzyme therapy and successful treatment with fibrin-thrombin sealant pleurodesis: a case report

Life-threatening pleural hemorrhage following intrapleural enzyme therapy and successful treatment with fibrin-thrombin sealant pleurodesis: a case report

Hemorrhagic Parapneumonic Effusion in a 64 Year-Old Patient as the First Symptom of Hemophilia B

Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema

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