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Intrapleural Tissue Plasminogen Activator for Traumatic Retained Hemothorax
Maya R Holsen1, Ashley M Tameron1, David C Evans1
11 The Ohio State University Wexner Medical Center, Columbus, OH, USA.
The Annals of Pharmacotherapy
|April 23, 2019
Summary
Intrapleural alteplase (tissue plasminogen activator) is an effective treatment for retained hemothorax, showing over 80% success with low bleeding risk. Higher doses are recommended compared to other indications.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Pharmacology
Background:
- Retained hemothorax is a significant complication following chest trauma or surgery.
- Current treatment options for retained hemothorax can be invasive, including surgical intervention.
- There is a need for effective, less invasive therapeutic strategies for retained hemothorax.
Purpose of the Study:
- To review the efficacy, safety, and optimal dosing of intrapleural alteplase for retained hemothorax.
- To provide evidence-based recommendations for alteplase administration in this patient population.
- To compare alteplase use in retained hemothorax to its use in other pleural conditions.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Google Scholar (2000-2019).
- Inclusion of retrospective reviews and meta-analyses on intrapleural alteplase for retained hemothorax in adults.
- Exclusion of single case reports and abstracts.
Main Results:
- A majority of studies reported an intrapleural alteplase success rate exceeding 80%.
- Bleeding complications were reported in less than 7% of cases.
- Dosing varied widely, with recommendations for higher doses and volumes in retained hemothorax compared to empyema.
Conclusions:
- Intrapleural alteplase is a viable alternative to surgery for retained hemothorax.
- Higher doses and volumes of alteplase are suggested for retained hemothorax.
- Further research is warranted to establish standardized protocols for alteplase administration.
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