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Published on: April 12, 2019

Intrapleural fibrinolysis for parapneumonic effusion and empyema in children

Robert G Wells1, Peter L Havens

  • 1Department of Radiology, MS 721, Children's Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226, USA. rwells@chw.org

Radiology
|August 2, 2003
PubMed

Insights

Alteplase and urokinase effectively treat pediatric parapneumonic effusions. Alteplase demonstrated greater pleural fluid drainage compared to urokinase, with both agents showing high success rates and safety.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Pharmacology

Background:

  • Parapneumonic pleural fluid collections are common in children.
  • Intrapleural fibrinolysis is a treatment option to facilitate pleural fluid drainage.
  • Urokinase and alteplase are commonly used fibrinolytic agents.

Purpose of the Study:

  • To compare the safety and efficacy of urokinase and alteplase for intrapleural fibrinolysis in pediatric patients with parapneumonic pleural fluid collections.
  • To evaluate the impact of these agents on thoracostomy tube drainage and treatment success.

Main Methods:

  • Retrospective review of 71 children treated with thoracostomy tubes and intrapleural urokinase or alteplase.
  • Analysis of demographic data, clinical signs and symptoms, laboratory results, and radiographic findings.
  • Comparison of treatment success, defined as resolution of signs and symptoms without surgery, and pleural fluid drainage between the two groups.

Main Results:

  • Both urokinase and alteplase demonstrated high primary treatment success rates (98% for alteplase, 100% for urokinase) with no major complications.
  • Alteplase resulted in significantly greater pleural fluid drainage during the first two days and over the entire duration of thoracostomy drainage compared to urokinase.
  • Multivariate analysis indicated that alteplase, older patient age, larger tube size, and higher pre-fibrinolysis drainage volume were associated with greater total drainage.

Conclusions:

  • Intrapleural fibrinolysis with either urokinase or alteplase is an effective method for managing parapneumonic pleural fluid collections in children.
  • Alteplase, under the dosing regimen used in this study, led to superior thoracostomy tube output compared to urokinase.
  • Both agents are safe and effective, but alteplase may offer advantages in terms of drainage efficiency.
Abstract

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