Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa: A Multicenter Retrospective Cohort Study

Area of Science:

• Pulmonology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Intrapleural instillation of tissue plasminogen activator (tPA) and DNase is utilized for loculated pleural effusions when initial drainage is insufficient.
• The real-world effectiveness of once-daily dosing protocols for these agents remains under investigation.

Purpose of the Study:

• To evaluate the real-world performance of pragmatic, once-daily intrapleural tissue plasminogen activator (tPA) and DNase protocols.
• To assess treatment success, drainage efficacy, and safety outcomes in patients with complicated pleural effusions, empyema, or hemothorax.

Main Methods:

• A retrospective cohort study was conducted across seven hospitals from January 1, 2019, to December 31, 2020.
• Adult patients receiving once-daily intrapleural tPA (20 or 50 mg) with optional DNase (5 mg) were included.
• Treatment success was defined as survival to hospital discharge without surgery; secondary outcomes included drainage, length of stay, and complications.

Main Results:

• Treatment success was observed in 85.0% of 120 patients.
• A significant median increase in chest tube drainage of 487.5 mL was noted (P < .001).
• Major bleeding occurred in 0.8% of patients, while 57.5% experienced pain requiring analgesia.

Conclusions:

• Standardized, once-daily intrapleural tPA with or without DNase is associated with high treatment success and improved drainage in a real-world setting.
• The regimen demonstrated a low rate of major bleeding.
• Findings suggest efficacy but caution is advised when comparing monotherapy and combination therapy due to non-randomized, imbalanced groups.