Recombinant tissue plasminogen activator in the treatment of pleural infections in adults.
BACKGROUND
Intrapleural recombinant tissue plasminogen activator (r-TPA) has been successfully evaluated in pediatric patients with complicated parapneumonic pleural effusion (CPE) and pleural empyema (PE). Yet, there is no data concerning r-TPA in adults with CPE/PE. The aim of our study was to investigate the efficacy and complications of r-TPA in adult patients with CPE/PE.


METHODS
Twenty consecutive patients (mean age 50+/-18.9 years) with pleural infection (14 CPE and 6 PE) were included. Chest tube was inserted under guidance of chest ultrasound and/or computed tomography. After failure of pleural fluid drainage, 25mg of r-TPA was administered intrapleurally in a single daily dose. The evaluation was made according to imaging and clinical status.


RESULTS
The mean volume of fluid increased significantly after r-TPA administration (p<0.0001). White blood cells count (WBC) and C-reactive protein (CRP) were significantly improved after r-TPA instillations (both p<0.0001). Significant clinical and imaging improvement was noted in all but one patient after r-TPA administration (overall p<0.0001). Complications observed were mild: pain in 4 (25%) and local bleeding in 3 (15%) patients. The median number of r-TPA instillations was 3 (range 2-5).


CONCLUSIONS
Intrapleural instillation of r-TPA at a dose of 25 mg is a well-tolerated and effective treatment in 95% of our adult patients with CPE/PE.
Froudarakis
Marios E
ME
Department of Pneumonology, Medical School, Democritus University of Thrace, Greece. mfroud@med.duth.gr
Kouliatsis
George
G
Steiropoulos
Paschalis
P
Anevlavis
Stavros
S
Pataka
Athanasia
A
Popidou
Maria
M
Mikroulis
Demitrios
D
Pneumatikos
Ioannis
I
Bouros
Demosthenes
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D015505:Chest Tubes; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000150:complications; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D011994:Recombinant Proteins; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator