Intrapleural fibrinolytic treatment of traumatic clotted hemothorax.
OBJECTIVE
To evaluate the role of intrapleural fibrinolytic treatment (IPFT) in traumatic clotted hemothorax.


METHODS
Between August 1995 and February 1997, 24 patients with traumatic clotted hemothorax were included. Streptokinase (SK), 250,000 IU, or urokinase (UK), 100,000 IU, diluted in 100 mL of saline solution was given daily. We administered 5.0+/-1.8 (range, 2 to 9) doses of SK or 6.25+/-5.97 (range, 2 to 15) doses of UK.


METHODS
Dicle University School of Medicine, Thoracic and Cardiovascular Surgery Department.


RESULTS
Complete response, which was defined as resolution of symptoms with complete drainage of fluid and no residual space radiographically, occurred in 15 (62.5%) patients. Partial response, which was defined as resolution of symptoms with a small pleural cavity, occurred in seven (29.2%) patients. Two patients (8.3%) required decortication; they were defined as nonresponders. The mean period of time between the diagnosis and fibrinolytic treatment (FT) was 11.65+/-6.38 (range, 4 to 25) days. There were no complications related to IPFT. There was no mortality during the course of IPFT.


CONCLUSIONS
The use of intrapleural fibrinolytic agents has resulted in resolution of clotted hemothorax with an overall success rate of 91.7%. We recommend that IPFT should be added to the algorithm for management of clotted hemothorax before proceeding with minithoracotomy or pleural decortication.
Inci
I
I
Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
Ozçelik
C
C
Ulkü
R
R
Tuna
A
A
Eren
N
N
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D004322:Drainage; D005069:Evaluation Studies as Topic; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006491:Hemothorax / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007267:Injections; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D010994:Pleura / Q000601:surgery; D012074:Remission Induction; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D013898:Thoracic Injuries / Q000150:complications*; D013908:Thoracotomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator