Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis

Faisal, Mohamed; Fazlin, M J Mas; Ng, Boon Hau; Nuratiqah, N A; Andrea, Yl. Ban

doi:10.1016/j.rmcr.2020.101111

Cited by 4 publications

(7 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dosing of t-PA used for intrapleural fibrinolysis varies from 4 to 100 mg per day [ 7 , 14 , 19 – 21 ], while the dose of intrapleural alteplase (t-PA) used in MIST-2 at 10 mg with supplemental pulmozyme (DNase) 5 mg twice daily for six doses is still empiric choice [ 7 ]. The rationale of this modified regimen of 16 mg t-PA with 5 mg DNase for total 3 doses that administered sequentially within 24 h reduced the frequency and time consuming for health care provider on administration of the drugs.…”

Section: Discussionmentioning

confidence: 99%

Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Cheong

Ban

et al. 2022

BMC Pulm Med

View full text Add to dashboard Cite

Background Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection. Methods This was a single centre, prospective study involving patients with poorly drained pleural infection. Primary outcome was the change of pleural opacity on chest radiograph at day 7 compared to baseline. Secondary outcomes include volume of fluid drained, inflammatory markers improvement, surgical referral, length of hospitalisation, and adverse events. Results Thirty patients were recruited. Majority, 27 (90%) patients were successfully treated. Improvement of pleural opacity on chest radiograph was observed from 36.9% [Interquartile range (IQR 21.8–54.9%)] to 18.1% (IQR 8.8–32.7%) of hemithorax (P < 0.05). T-PA/DNase increased fluid drainage from median of 45 mls (IQR 0–100) 24 h prior to intrapleural treatment to 1442 mls (IQR 905–2360) after 72 h; (P < 0.05) and reduction of C-reactive protein (P < 0.05). Pain requiring escalation of analgesia affected 20% patients and 9.9% experienced major adverse events. None required surgical intervention. Conclusion This study suggests that a modified regimen 16 mg t-PA with 5 mg DNase can be safe and effective for patients with poorly drained complex pleural infection. Trial registration The study was registered retrospectively on 07/06/2021 with ClinicalTrials number NCT04915586 (https://clinicaltrials.gov/ct2/show/NCT04915586).

show abstract

Section: Discussionmentioning

confidence: 99%

Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Cheong

Ban

et al. 2022

BMC Pulm Med

View full text Add to dashboard Cite

show abstract

“…There has been extensive research and publication on the combination of intrapleural alteplase and DNase. Different studies have demonstrated effective doses of alteplase ranging from as low as 2.5–50 mg/day [ 1 , 2 , [5] , [6] , [7] , [8] , [9] ]. In our case series, we used 3 doses of intrapleural alteplase 16 mg per instillation 8 hours apart over 24 hours.…”

Section: Discussionmentioning

confidence: 99%

“…The dose of 16 mg alteplase was chosen to maximise its utilisation per day and to reduce drug instability after 24 hours of dilution; as the formulation of alteplase in our centre was 50 mg per vial [ 2 ]. This dose allows 3 instillations of 16 mg alteplase within 24 hours in combination with DNase.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection

Faisal

Farhan

Cheong

et al. 2020

Respiratory Medicine Case Reports

Self Cite

View full text Add to dashboard Cite

Pleural infection is a common clinical condition leading to hospitalisation. In the last decade, advances in pleural research have led to a paradigm shift in the treatment of complex effusion from a surgical approach to a less invasive non-surgical approach using a combination of intrapleural fibrinolytics and pulmozyme (DNase). We report 3 patients with pleural infection. Intercostal chest catheter failed to drain the complex effusion. They were subsequently treated with a modified short-course regimen of alteplase and DNase. They received 3 cycles of 16 mg alteplase with 5 mg DNase each within 24 hours and all three had a favourable outcome with no adverse effects. This modified regimen appears effective with good safety profile and adds to the current literature on the safety and effectiveness of different dose combinations of alteplase and DNase.

show abstract

“…IFET is associated with a risk of 4.1% for pleural bleeding and 6.3% for systemic bleeding 1. The reported doses of tPA/DNase used in patients with a high risk of bleeding ranges from 0.5 mg to 2.5 mg 2 3. In patients with recent surgery, the use of IFET is debatable due to the bleeding risk.…”

Section: Introductionmentioning

confidence: 99%

Combined intrapleural alteplase and DNase therapy in complicated pleural infection arising from postsurgery oesophageal leak

Ng,

Nik Abeed,

Ban

et al. 2023

BMJ Case Rep

View full text Add to dashboard Cite

Managing a complicated pleural infection related to postsurgery can pose a clinical challenge, especially when initial interventions such as intercostal chest drain and antibiotics prove ineffective. We describe a man in his mid-60s who developed a recurrence of exudative pleural effusion caused by an oesophageal leak following laparoscopic total gastrectomy with Roux-y oesophagojejunostomy for gastric adenocarcinoma. Surgical repairs and oesophageal stenting were performed to address the oesophageal leak. Despite attempts at intercostal chest tube drainage, ultrasonography-guided targeted drainage of the locule and antibiotics, he did not show any improvement. He was unfit for surgical decortication. Due to the risk of bleeding, we chose a modified dose of intrapleural alteplase 5 mg and DNase 5 mg at 12-hour intervals for a total of three doses. This led to the complete resolution of the effusion. This case highlights that intrapleural tPA/DNase can be an adjunctive therapy in postsurgery-related complicated pleural effusion.

show abstract

Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis

Cited by 4 publications

References 13 publications

Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection

Combined intrapleural alteplase and DNase therapy in complicated pleural infection arising from postsurgery oesophageal leak

Contact Info

Product

Resources

About