Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions—analysis of predictors for failure of therapy and bleeding: a cohort study

Abstract

ObjectivesTo assess risk factors associated with failure and bleeding in intrapleural fibrinolytic therapy (IPFT) for pleural effusions.DesignRetrospective case series.SettingTwo tertiary-care centres in North America.ParticipantsWe identified 237 cases that received IPFT for the treatment of pleural effusions. Data for 227 patients were compiled including demographics, investigations, radiological findings pretherapy and post-therapy and outcomes.InterventionFibrinolytic therapy in the form of tissue plasminogen activator (t-PA) or streptokinase.Primary and secondary outcomesSuccess of therapy is defined as the presence of both clinical and radiological improvement leading to resolution. Failure was defined as persistence (ie, ineffective treatment) or complications requiring intervention from IPFT. Incidence of bleeding post-IPFT, identifying factors related to failure of therapy and bleeding.ResultsIPFT was used in 237 patients with pleural effusions; 163 with empyema/complicated parapneumonic effusions, 32 malignant effusions and 23 with haemothorax. Overall, resolution was achieved in 80% of our cases. Failure occurred in 46 (20%) cases. Multivariate analysis revealed that failure was associated with the presence of pleural thickening (>2 mm) on CT scan (p=0.0031, OR 3, 95% CI 1.46 to 6.57). Bleeding was not associated with any specific variable in our study (antiplatelet medications, p=0.08).ConclusionsPleural thickening on a CT scan was found to be associated with failure of IPFT.

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

“…In spite of the small number of patients included in our study, the commonest cases we faced were empyema and parapneumonic effusion (64%). This was comparable with Abu-Daff et al in 2012 who used intrapleural fibrinolytics in 237 patients with loculated pleural effusion and about 68% of the cases were empyema and complicated parapneumonic effusion [6].…”

“…Since then, there have been many studies which support the use of fibrinolytic agents in empyema and parapneumonic effusion treatment. These agents may be a safer, easier and cost effective option for managing pleural adhesions and loculations [6]. This work is considered the first study in Assiut University Hospital about the therapeutic role of intrapleural fibrinolytics.…”

Intrapleural Fibrinolysis in Post-tubercular Loculated Pleural Effusions at a Tertiary-Care Respiratory Center: An Uncontrolled Blinded Before-After Intervention Study

“…Fibrinous locules remain a major obstacle to effective drainage in an infected pleural cavity. [18][19][20][21] IPFT with urokinase in loculated pleural effusion resulted in statistically significant reduction in the residual amount of fluid as noted by other researchers.…”

Dose dependency of outcomes of intrapleural fibrinolytic therapy in new rabbit empyema models

“…These comprise important morphological features, as clinical loculation impairs pleural drainage in patients with EMP and is associated with increased morbidity (16,40). Increased pleural thickness has likewise been associated with poor outcomes of IPFT in these patients (1,3). Fibrinous coating of the pleural surfaces with adhesion formation was observed over 72 h of EMP in both models (Fig.…”