Intrapleural r-tPA in association with low-molecular heparin may cause massive hemothorax resulting in hypovolemia.
The use of intrapleural instillation of recombinant tissue plasminogen activator (r-tPA) in the treatment of pleural infection may increase pleural fluid drainage associated with a clinical and imaging improvement, leading to a faster resolution. The use of r-tPA is generally well tolerated. Here we report 2 cases of massive pleural hemorrhage resulting in life-threatening hypovolemia, in 2 patients treated with intrapleural r-tPA for a pleural infection, who were simultaneously receiving systemic anticoagulation (1 therapeutic, the second prophylactic) with low-molecular weight heparin. It appears that the decision of treating pleural infection with r-tPA in patients receiving therapeutic or prophylactic systemic anticoagulation must be well balanced and in case of association of these compounds, close monitoring is necessary.
Department of Pneumonology, and CardioThoracic Surgery Medical School, Democritus University of Thrace, Alexandroupolis, Greece. anevlavis @ yahoo.com
Stavros
S
Anevlavis
Kostas
K
Archontogeorgis
Argyris
A
Tzouvelekis
George
G
Kouliatsis
Sofia
S
Pozova
Ioannis
I
Bougioukas
Demosthenes
D
Bouros
Marios E
ME
Froudarakis
D000368:Aged; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006491:Hemothorax / Q000139:chemically induced* / Q000150:complications; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects*; D006801:Humans; D020896:Hypovolemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010959:Tissue Plasminogen Activator