BACKGROUND: This study is aimed at evaluating the safety and efficacy of intrapleural tissue plasminogen activator (TPA) for complicated pleural effusions, including posttraumatic hemothorax. METHODS: Data were retrospectively collected from hospitalized patients over a 4-year period (1999-2003) who were treated with intrapleural TPA after failing drainage by tube thoracostomy. Pre- and post-TPA imaging studies were reviewed and scored by a blinded radiologist. RESULTS: Forty-one consecutive patients with 42 effusions were identified with the following indications: 6 traumatic hemothoraces (14%), 22 loculated pleural effusions (52%), 2 line-associated hemothoraces (5%), and 12 empyemas (29%). Nine patients (22%) required operative drainage including two with posttraumatic hemothoraces. All patients managed nonoperatively demonstrated radiographic improvement after TPA administration. One patient (2.4%) developed hematuria, requiring transfusion. No trauma patient required TPA-related blood transfusion and no deaths were attributable to TPA therapy. CONCLUSION: Intrapleural TPA administration appears safe for use in complicated pleural effusions and may decrease the need for operative intervention.
BACKGROUND: This study is aimed at evaluating the safety and efficacy of intrapleural tissue plasminogen activator (TPA) for complicated pleural effusions, including posttraumatic hemothorax. METHODS: Data were retrospectively collected from hospitalized patients over a 4-year period (1999-2003) who were treated with intrapleural TPA after failing drainage by tube thoracostomy. Pre- and post-TPA imaging studies were reviewed and scored by a blinded radiologist. RESULTS: Forty-one consecutive patients with 42 effusions were identified with the following indications: 6 traumatic hemothoraces (14%), 22 loculated pleural effusions (52%), 2 line-associated hemothoraces (5%), and 12 empyemas (29%). Nine patients (22%) required operative drainage including two with posttraumatic hemothoraces. All patients managed nonoperatively demonstrated radiographic improvement after TPA administration. One patient (2.4%) developed hematuria, requiring transfusion. No traumapatient required TPA-related blood transfusion and no deaths were attributable to TPA therapy. CONCLUSION: Intrapleural TPA administration appears safe for use in complicated pleural effusions and may decrease the need for operative intervention.
Authors: Maren E Shipe; Amelia W Maiga; Stephen A Deppen; Diane N Haddad; Erin A Gillaspie; Fabien Maldonado; Benjamin D Kozower; Eric L Grogan Journal: Ann Thorac Surg Date: 2020-11-27 Impact factor: 4.330
Authors: Jana B MacLeod; Jeffrey S Ustin; Joseph T Kim; Fran Lewis; Grace S Rozycki; David V Feliciano Journal: Eur J Trauma Emerg Surg Date: 2009-12-22 Impact factor: 3.693
Authors: Saleh Abu-Daff; Donna E Maziak; Derar Alshehab; Jennifer Threader; Jelena Ivanovic; Valerie Deslaurier; Patrick-James Villeneuve; Sebastian Gilbert; Sudhir Sundaresan; Farid Shamji; Colleen Lougheed; Jean M Seely; Andrew J E Seely Journal: BMJ Open Date: 2013-01-31 Impact factor: 2.692