Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax.
BACKGROUND
When retained hemothorax occurs, video-assisted thoracoscopy or thoracotomy is performed, but recently, tissue plasminogen activator (tPA) has been used. This study evaluated intrapleural tPA use for retained traumatic hemothoraces.


METHODS
A retrospective review was conducted of trauma patients treated with intrapleural tPA for retained hemothorax. Data included demographics, past medical and surgical histories, injury details, treatment details, and outcomes.


RESULTS
Seven patients (median age = 47 years, male = 6, blunt trauma = 6) met study criteria. All patients received a chest tube. Six patients later received computed tomography-guided drains for tPA infusion. Number of tPA treatments per patient varied from 1 to 5. Median total tPA dosage was 24 mg. Median time from injury to chest tube placement was 11 days and from chest tube placement to first tPA treatment was 4 days. No patients required a video-assisted thoracoscopy; however, 1 patient required thoracotomy. There were no deaths or bleeding complications attributed to intrapleural tPA.


CONCLUSIONS
Although future studies are needed to identify optimum treatment guidelines, intrapleural tPA appears to be a safe and efficacious treatment option.
Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Room 3082, Wichita, KS 67214, USA.
P J
PJ
Stiles
Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Room 3082, Wichita, KS 67214, USA.
Rachel M
RM
Drake
Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Room 3082, Wichita, KS 67214, USA; Department of Medical Education, Room 3082, Via Christi Hospital on Saint Francis, 929 North Saint Francis Street, Wichita, KS 67214, USA.
Stephen D
SD
Helmer
Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Room 3082, Wichita, KS 67214, USA.
Paul M
PM
Bjordahl
Department of Surgery, The University of Kansas School of Medicine-Wichita, 929 North Saint Francis Street, Room 3082, Wichita, KS 67214, USA; Department of Trauma Services, Room 2514, Via Christi Hospital on Saint Francis, 929 North Saint Francis Street, Wichita, KS 67214, USA. Electronic address: James.Haan.Research@viachristi.org.
James M
JM
Haan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006491:Hemothorax / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Fibrinolysis; Intrapleural; Retained hemothorax; Tissue plasminogen activator; Trauma