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Bleeding Risk With Combination Intrapleural Fibrinolytic and Enzyme Therapy in Pleural Infection: An International,
Jason Akulian1, Eihab O Bedawi2, Hawazin Abbas3
1Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Carolina Center for Pleural Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
Chest
|June 18, 2022
Summary
Intrapleural enzyme therapy (IET) for pleural infection has a low bleeding risk. Avoid concurrent anticoagulation with IET to mitigate increased bleeding, especially in high-risk patients.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Thoracic Surgery
Background:
- Intrapleural enzyme therapy (IET) is a treatment for pleural infection.
- Its safety profile, especially regarding bleeding and concurrent anticoagulation, requires further definition.
Purpose of the Study:
- To assess the bleeding complication risk associated with IET in pleural infection.
- To identify factors influencing IET-related bleeding.
Main Methods:
- Multicenter, retrospective observational study of 1,851 patients treated with IET.
- Data collected on pleural bleeding, concurrent anticoagulation, and patient factors.
- Primary outcome: incidence of pleural bleeding.
Main Results:
- Overall pleural bleeding incidence was 4.1%.
- Concurrent therapeutic anticoagulation significantly increased bleeding risk (9.6% vs. 2.6%).
- Higher RAPID score and systemic anticoagulation were independent predictors of bleeding.
Conclusions:
- IET has a low overall bleeding risk in pleural infection.
- Withholding anticoagulation before IET mitigates bleeding risk.
- Avoid concomitant IET and therapeutic anticoagulation; identify high-risk patients for altered treatment thresholds.
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