Establishing a role for intra-pleural fibrinolysis in managing traumatic haemothoraces

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether there is a role in using intra-pleural fibrinolysis or thrombolysis with an agent such as streptokinase aids in resolving haemothoraces following trauma. Twenty-four papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that intra-pleural fibrinolytic does have a role in managing patients with unresolved haemathoraces with complete resolution clinically and radiologically in most patients in half of the studies reviewed. It may be used as an alternative to surgical intervention in certain patients, but little work has been done on comparing intra-pleural fibrinolysis directly to surgical evacuation. The choice of agent and number of administrations are variable but with a similar outcome. Few studies have compared agents. The timing of when to use these agents following the traumatic haemothorax was variable but its use was commonly reserved following 'failure' of chest drainage clinically or radiologically (so usually over a week following the original injury). The overall morbidity including bleeding complications from their use was reported as low.