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An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug
Published on: June 4, 2021
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Intrapleural Fibrinolytic Therapy: Past, Present, and Future
Peter K Moore1, Daniel M Hershberger2, Christopher D Barrett3
1Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Chest
|September 12, 2025
Summary
Intrapleural fibrinolytic therapy for complicated parapneumonic effusion/empyema is inefficient, leading to prolonged hospital stays and high costs. Understanding resistance mechanisms can improve treatment outcomes and reduce healthcare expenditure.
Area of Science:
- Pulmonary Medicine
- Cardiovascular Medicine
- Biochemistry
Background:
- Fibrinolysis and empyema share a historical link, with early plasminogen activator discoveries from Streptococcus species.
- The first clinical use of plasminogen activators was intrapleural streptokinase for parapneumonic effusion.
- Current therapy uses recombinant tissue plasminogen activator and deoxyribonuclease-1, but remains inefficient.
Purpose of the Study:
- To provide a historical overview of intrapleural fibrinolysis.
- To review current clinical fibrinolytic therapy for complicated parapneumonic effusion/empyema.
- To highlight knowledge gaps in the pathobiology of resistance to intrapleural fibrinolytic therapy.
Main Methods:
- Historical literature review.
- Analysis of current clinical practices in fibrinolytic therapy.
- Identification of research gaps in pleural space fibrinolysis.
Main Results:
- Current intrapleural fibrinolytic therapy is associated with an average 14-day hospital stay.
- Many patients experience residual pleural effusion, necessitating surgery.
- Significant healthcare expenditure is linked to these treatments.
Conclusions:
- Improved understanding of pleural space fibrinolysis mechanisms can enhance prognostication.
- Knowledge advancements may guide precision therapeutics for better patient outcomes.
- Addressing resistance to intrapleural fibrinolytic therapy can reduce healthcare costs.
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