title: Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study.
abstract: OBJECTIVE
  To assess risk factors associated with failure and bleeding in intrapleural fibrinolytic therapy (IPFT) for pleural effusions.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Two tertiary-care centres in North America.
  
  
  METHODS
  We identified 237 cases that received IPFT for the treatment of pleural effusions. Data for 227 patients were compiled including demographics, investigations, radiological findings pretherapy and post-therapy and outcomes.
  
  
  METHODS
  Fibrinolytic therapy in the form of tissue plasminogen activator (t-PA) or streptokinase.
  
  
  METHODS
  Success of therapy is defined as the presence of both clinical and radiological improvement leading to resolution. Failure was defined as persistence (ie, ineffective treatment) or complications requiring intervention from IPFT. Incidence of bleeding post-IPFT, identifying factors related to failure of therapy and bleeding.
  
  
  RESULTS
  IPFT was used in 237 patients with pleural effusions; 163 with empyema/complicated parapneumonic effusions, 32 malignant effusions and 23 with haemothorax. Overall, resolution was achieved in 80% of our cases. Failure occurred in 46 (20%) cases. Multivariate analysis revealed that failure was associated with the presence of pleural thickening (>2 mm) on CT scan (p=0.0031, OR 3, 95% CI 1.46 to 6.57). Bleeding was not associated with any specific variable in our study (antiplatelet medications, p=0.08).
  
  
  CONCLUSIONS
  Pleural thickening on a CT scan was found to be associated with failure of IPFT.
authors: Division of Thoracic Surgery, Department of Surgery,  University of Ottawa and the Ottawa Hospital, Ottawa,  Canada.
authors: Saleh
authors: S
authors: Abu-Daff
authors: Donna E
authors: DE
authors: Maziak
authors: Derar
authors: D
authors: Alshehab
authors: Jennifer
authors: J
authors: Threader
authors: Jelena
authors: J
authors: Ivanovic
authors: Valerie
authors: V
authors: Deslaurier
authors: Patrick-James
authors: PJ
authors: Villeneuve
authors: Sebastian
authors: S
authors: Gilbert
authors: Sudhir
authors: S
authors: Sundaresan
authors: Farid
authors: F
authors: Shamji
authors: Colleen
authors: C
authors: Lougheed
authors: Jean M
authors: JM
authors: Seely
authors: Andrew J E
authors: AJ
authors: Seely
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