Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis.
BACKGROUND
Randomized controlled trials have shown conflicting findings about the role of intrapleural fibrinolytic therapy for the treatment of empyema and complicated parapneumonic effusions in adult patients.


OBJECTIVE
To assess the clinical efficacy and summarize the current evidence of intrapleural fibrinolytic use in patients with empyema and complicated parapneumonic effusions in adult patients.


METHODS
We performed a meta-analysis of all properly randomized trials comparing intrapleural fibrinolytic agents with placebo in adult patients with empyema and complicated parapneumonic effusions. Outcome of primary interest was the reduction of death and surgical intervention.


RESULTS
We included five trials totaling 575 patients. The number of enrolled patients for each trial was small, except for the recent trial by Multicenter Intrapleural Sepsis Trial (MIST1) group. Compared with placebo, intrapleural fibrinolytic therapy was associated with a nonsignificant reduction in death and need for surgery (27.6% of the treatment group vs 32.8% of the control group; random-effects pooled risk ratio, 0.55; 95% confidence interval, 0.28 to 1.07; heterogeneity, p = 0.023). A separate analysis for outcomes on either death or need for surgery also showed nonsignificant results.


CONCLUSIONS
Our meta-analysis does not support the routine use of fibrinolytic therapy for all patients who require chest tube drainage for empyema or complicated parapneumonic effusions. However, there was significant heterogeneity of the treatment effects among the trials. Selected patients might benefit from the treatment.
Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan. tokuyasu@orange.ocn.ne.jp
Yasuharu
Y
Tokuda
Dai
D
Matsushima
Gerald H
GH
Stein
Seishirou
S
Miyagi
D000328:Adult; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000601:surgery; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010996:Pleural Effusion / Q000188:drug therapy* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D005343:Fibrinolytic Agents