Intrapleural alteplase in a patient with complicated pleural effusion.
OBJECTIVE
To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE).


METHODS
A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention.


CONCLUSIONS
While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE.


CONCLUSIONS
This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.
Walker
Charlotte A
CA
Chalmers P Wylie Veterans Affairs Outpatient Clinic, Columbus, OH, USA.
Shirk
Mary Beth
MB
Tschampel
Marva M
MM
Visconti
James A
JA
D004334:Drug Administration Schedule; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007322:Instillation, Drug; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator