Tenecteplase for malignant pericardial effusion.
Pericardial effusions may necessitate placement of a catheter into the pericardial space for continuous drainage. If the effusion material is fibrinous or loculated, drainage may slow or cease over time, allowing reaccumulation. Limited data exist to guide the selection of a fibrinolytic agent and the most appropriate dose. We report the case of a 79-year-old woman with malignant pericardial effusion who responded to intrapericardial administration of tenecteplase to facilitate drainage. The patient received three doses of tenecteplase--15 mg, 7.5 mg, and 7.5 mg--over 3 days, resulting in significant drainage. No adverse effects were noted except for a transient episode of hemodynamically stable atrial fibrillation. Use of fibrinolytic agents to facilitate pericardial drainage may offset the need to repeatedly replace the catheter if flow subsides despite continued presence of fluid in the pericardial space.
Johnson
Kelly K
KK
Department of Pharmacy, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA. kelly.johnson@advocatehealth.com
Soundarraj
Dwarakraj
D
Patel
Parag
P
D000368:Aged; D001281:Atrial Fibrillation; D004322:Drainage / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008479:Mediastinal Neoplasms / Q000188:drug therapy*; D010490:Pericardial Effusion / Q000188:drug therapy* / Q000473:pathology; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase