title: Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials.
abstract: BACKGROUND
  The effects of intrapleural fibrinolysis for treating pleural empyema and parapneumonic effusion remain uncertain.
  
  
  OBJECTIVE
  We conducted a meta-analysis of published randomized controlled trials (RCTs) to evaluate the efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion.
  
  
  METHODS
  Medline, Web of Science, Ovid and regulatory documents up to June 10, 2012 were searched. We selected RCTs on intrapleural fibrinolysis vs placebo control treatment for pleural empyema and parapneumonic effusion. The meta-analysis was used to determine the odds ratios (OR) for death, surgical intervention and severe side effects, and weighted mean differences were used to estimate lengths of hospital stays.
  
  
  RESULTS
  Ten trials with a total of 977 patients were included. Compared with a placebo, intrapleural fibrinolytic therapy decreased the OR for surgical intervention [OR = 0.24; 95% confidence interval (CI): 0.10-0.60] and the length of hospital stays (weighted mean difference = -6.47; 95% CI: -8.87, -4.08). Intrapleural fibrinolysis was associated with a non-significant reduction in mortality rate (OR = 1.16; 95% CI: 0.71-1.89) and a non-significant increase in severe side effects (OR = 1.92; 95% CI: 0.87-4.21). Subgroup analyses indicated that urokinase agents had marked positive effects on reducing surgical intervention (OR = 0.33; 95% CI: 0.14-0.78), but neither streptokinase nor tissue plasminogen activator did.
  
  
  CONCLUSIONS
  The present results show that intrapleural fibrinolysis with urokinase may be potentially effective for reducing the need for surgery. Intrapleural fibrinolytic therapy is effective for shortening the lengths of hospital stays without increasing the incidence of severe side effects.
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
authors.forename: Wencheng
authors.initials: W
authors.lastname: Nie
authors.forename: Yanru
authors.initials: Y
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Liuhong
authors.initials: L
authors.lastname: Shi
authors.forename: Fangchun
authors.initials: F
authors.lastname: Shao
authors.forename: Kejing
authors.initials: K
authors.lastname: Ying
authors.forename: Ruifeng
authors.initials: R
authors.lastname: Zhang
mesh_terms: D016724:Empyema, Pleural / Q000188:drug therapy* / Q000401:mortality; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D010996:Pleural Effusion / Q000188:drug therapy* / Q000401:mortality; D011014:Pneumonia / Q000150:complications / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents
keywords: fibrinolytic; intrapleural; meta-analysis; parapneumonic effusion; pleural empyema