Comparison of the Efficacies of Alteplase and Streptokinase Used for Fibrinolytic Treatment in Parapneumonic Pleural Effusion and Empyema
Research Article
DOI:
https://doi.org/10.5281/zenodo.13751912Keywords:
Alteplase, Streptokinase, Fibrinolytic Treatment, Parapneumonic Pleural Effusion, EmpyemaAbstract
Introduction: Used rarely in the fibrinolytic treatment of parapneumonic pleural effusion (PPE) and empyema, alteplase is a plasminogen activator (tPA) analogue.
Objective: In our study, we divided the patients with PPE and empyema, to whom we implemented video-assisted thoracic surgery, into two groups and we implemented VATS to one group and alteplase plus fibrinolysis following VATS to the other. We compared these two groups through clinical and biochemical parameters.
Methods: Totally 66 patients were involved in the study. The patients were divided into 2 groups randomly. 5-20 mg alteplase was administered to 40 patients in the first group (Alteplase) through tube thoracostomy following VATS. And only VATS was implemented to 26 patients in the second group (Control). The chest tube removal times of the patients and their lengths of hospitalization, C-Reactive Protein (CRP) and White Blood Cells (WBC) values were compared statistically.
Results: It was determined that the groups were homogeneous statistically (P>0.05), CRP values (11.99±9.63) in the alteplase group were statistically significantly higher comparing to the control (4.07±5.10) group (P<0.05), Alteplase group was better in the comparison of the removal times of chest tubes, lengths of hospitalization and WBC values, however the findings were not statistically significant (P>0.05).
Conclusion: Alteplase is a significantly efficient fibrinolytic treatment with a success rate of 87.5%, which can be used in PPE and empyema with minimum side effects in appropriate dosages.
References
Noppen M, De Waele M, Li R, Gucht KV, D’Haese J, Gerlo E et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med. 2000;162:1023-1026.
Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg. 2007;133:346-351.
Maskell NA, Davies CW, Nunn AJ, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352:865-874.
Heffne JE, Klein JS, Hampson C. Interventional management of pleural infections. Chest. 2009;136:1148-1159.
Chapman SJ, Davies RJ. Recent advances in parapneumonic effusions and empyema. Curr Opin Pulm Med. 2004;10:299- 304.
Generali JA, Cada DJ. Alteplase: pleural effusion (parapneumonic) and empyema in children. Hosp Pharm. 2013;48:912-921.
Thommi G, Nair CK, Aronow WS, Shehan C, Meyers P, McLeay M. Efficacy and safety of intrapleural instillation of alteplase in the management of complicated pleural effusion or empyema. Am J Ther. 2007;14:341-345.
Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365:518-526.
Taylor JL, Liu M, Hoff DS. Retrospective analysis of large-dose intrapleural alteplase for complicated pediatric parapneumonic effusion and empyema. J Pediatr Pharmacol Ther. 2015;20:128-137.
Yasar A S, Bicer A, Turhan H, Sasmaz H. Third Generation Thrombolytic Agents in the Guidance of Trials. Arch Turk Soc Cardiol. 2004;32:564-570.
Froudarakis ME, Kouliatsis G, Steiropoulos P, et al. Recombinant tissue plasminogen activator in the treatment of pleural infections in adults. Resp Med. 2008;102:1694-1700.
Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bolliger CT. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med. 2004;170:49-53.
Davies RJO, Traill ZC, Gleeson FV. Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax. 1997;52:416-421.
Bouros D, Schiza S, Tzanakis N, Chalkiadakis G, Drositis J, Siafakas N. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized, doubleblind study. Am J Respir Crit Care Med. 1999;159:37-42.
Ozcelik C, Inci I. Nizam O, Onat S. Intrapleural fibrinolytic treatment of multiloculated postpneumonic empyemas. Ann Thorc Surg. 2003;76:1849-1853.
Gervais DA, Levis DA, Hahn PF, Uppot RN, Arellano RS, Mueller PR. Adjunctive intrapleural tissue plasminogen activator administrated via chest tube placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology. 2008;246: 956-963.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Medica Ruha
This work is licensed under a Creative Commons Attribution 4.0 International License.