Streptokinase for malignant pleural effusions: a randomized controlled study.

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Oncology

Background:

• Malignant pleural effusion requires effective palliative treatment.
• Lung reexpansion is crucial for successful palliative interventions like pleurodesis.
• Fibrin deposits can impede lung reexpansion after pleural fluid drainage.

Purpose of the Study:

• To investigate the efficacy of intrapleural fibrinolytics in lysing fibrin deposits.
• To assess the improvement in lung reexpansion following fibrinolytic therapy.
• To compare pleurodesis outcomes in patients receiving intrapleural streptokinase versus standard drainage.

Main Methods:

• A randomized controlled trial involving 47 patients with malignant pleural effusion.
• Patients were allocated to receive either intrapleural streptokinase (250,000 U for 3 cycles) or pleural drainage alone.
• Lung reexpansion was assessed via chest radiography, and pleurodesis with talc slurry was performed if adequate.

Main Results:

• Adequate lung reexpansion for talc pleurodesis was achieved in 96% of the fibrinolytic group versus 74% in the control group.
• The mean daily pleural drainage volume significantly increased from 425 mL to 737 mL after streptokinase administration.
• Patient characteristics were similar between the two groups, indicating reliable comparison.

Conclusions:

• Intrapleural streptokinase administration is advisable for patients with malignant pleural effusion.
• Fibrinolytic therapy improves lung reexpansion, facilitating successful pleurodesis.
• This approach enhances the effectiveness of palliative treatment for malignant pleural effusion.