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Intrapleural tissue plasminogen activator for complicated pleural effusions
Dionne A Skeete1, Edmund J Rutherford, Scott A Schlidt
1Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
The Journal of Trauma
|December 31, 2004
Summary
Intrapleural tissue plasminogen activator (TPA) is safe and effective for complicated pleural effusions, potentially reducing the need for surgery. This treatment showed positive radiographic outcomes in patients who did not respond to initial drainage.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Interventional Radiology
Background:
- Complicated pleural effusions, including posttraumatic hemothorax, pose significant management challenges.
- Intrapleural administration of tissue plasminogen activator (TPA) is explored as a therapeutic option.
- Previous drainage methods like tube thoracostomy may not always be sufficient.
Purpose of the Study:
- To evaluate the safety and efficacy of intrapleural TPA for complicated pleural effusions.
- To assess the impact of TPA on the need for surgical intervention.
- To analyze outcomes in patients with various types of pleural effusions, including hemothorax.
Main Methods:
- Retrospective data collection from hospitalized patients over a 4-year period (1999-2003).
- Patients received intrapleural TPA after failing initial tube thoracostomy drainage.
- Radiographic studies before and after TPA treatment were reviewed and scored by a blinded radiologist.
Main Results:
- Forty-one patients with 42 effusions were treated, including traumatic hemothoraces, loculated effusions, line-associated hemothoraces, and empyemas.
- Twenty-two percent of patients required subsequent operative drainage.
- All nonoperatively managed patients showed radiographic improvement; TPA-related complications were minimal (one case of hematuria).
Conclusions:
- Intrapleural TPA is a safe therapeutic option for complicated pleural effusions.
- TPA administration may reduce the necessity for surgical intervention in managing these conditions.
- The study supports TPA as an effective adjunct to drainage in selected pleural effusion cases.