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Recombinant tissue plasminogen activator in the treatment of pleural infections in adults

Marios E Froudarakis1, George Kouliatsis, Paschalis Steiropoulos

  • 1Department of Pneumonology, Medical School, Democritus University of Thrace, Greece. mfroud@med.duth.gr

Respiratory Medicine
|October 1, 2008
PubMed

Insights

Intrapleural recombinant tissue plasminogen activator (r-TPA) effectively treated 95% of adult patients with complicated parapneumonic pleural effusion (CPE) and pleural empyema (PE). This treatment showed significant clinical and imaging improvements with mild complications.

Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Recombinant tissue plasminogen activator (r-TPA) has proven effective in pediatric pleural infections.
  • Limited data exists on r-TPA efficacy in adult complicated parapneumonic effusion (CPE) and pleural empyema (PE).

Purpose of the Study:

  • To evaluate the efficacy and safety of intrapleural r-TPA in adult patients diagnosed with CPE or PE.
  • To determine the treatment success rate and identify potential complications associated with r-TPA administration in this population.

Main Methods:

  • Twenty adult patients with pleural infection (14 CPE, 6 PE) received intrapleural r-TPA (25mg daily) after chest tube insertion and failed drainage.
  • Treatment efficacy was assessed via clinical status and imaging, with complications meticulously recorded.

Main Results:

  • Intrapleural r-TPA administration led to significant improvements in fluid volume, white blood cell count, and C-reactive protein levels (p<0.0001).
  • Ninety-five percent of patients experienced significant clinical and imaging improvement.
  • Observed complications were mild, including pain (25%) and local bleeding (15%).

Conclusions:

  • Intrapleural r-TPA at 25mg per dose is a well-tolerated and highly effective treatment for adult CPE and PE.
  • The study supports the use of intrapleural r-TPA as a viable therapeutic option for adult pleural infections.
Abstract

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