title: The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses: 25 Cases (2007-2012).
abstract: BACKGROUND
  Information about treatment protocols, adverse effects and outcomes with intrapleural recombinant tissue plasminogen activator (rTPA) use in horses with fibrinous pleuropneumonia is limited.
  
  
  OBJECTIVE
  Describe factors that contribute to clinical response and survival of horses treated with rTPA intrapleurally.
  
  
  METHODS
  Horses with bacterial pneumonia and fibrinous pleural effusion diagnosed by ultrasonography, that were treated with rTPA intrapleurally.
  
  
  METHODS
  Retrospective multicenter case series from 2007-2012. Signalment, history, clinical and laboratory evaluation, treatment, and outcome obtained from medical records. Regression analysis used to identify associations between treatments and outcomes.
  
  
  RESULTS
  Thirty three hemithoraces were treated in 25 horses, with 55 separate treatments. Recombinant tissue plasminogen activator (375-20,000 μg/hemithorax) was administered 1-4 times. Sonographically visible reduction in fibrin mat thickness, loculations, fluid depth, or some combination of these was seen in 32/49 (65%) treatments. Response to at least 1 treatment was seen in 17/20 (85%) horses with sonographic follow-up evaluation after every treatment. Earlier onset of rTPA treatment associated with increased survival odds. No association was found between cumulative rTPA dose or number of rTPA doses and survival, development of complications, duration of hospitalization or total charges. Clinical evidence of hypocoagulability or bleeding was not observed. Eighteen horses (72%) survived to discharge.
  
  
  CONCLUSIONS
  Treatment with rTPA appeared safe and resulted in variable changes in fibrin quantity and organization within the pleural space. Recombinant tissue plasminogen activator could be a useful adjunct to standard treatment of fibrinous pleuropneumonia, but optimal case selection and dosing regimen remain to be elucidated.
authors.affiliation: Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
authors.forename: J E
authors.initials: JE
authors.lastname: Tomlinson
authors.affiliation: Alamo Pintado Equine Medical Center, Los Olivos, CA.
authors.forename: E
authors.initials: E
authors.lastname: Byrne
authors.affiliation: Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA.
authors.forename: N
authors.initials: N
authors.lastname: Pusterla
authors.affiliation: Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA.
authors.forename: K Gary
authors.initials: KG
authors.lastname: Magdesian
authors.affiliation: Departments of Structural Biology and Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA.
authors.forename: H G
authors.initials: HG
authors.lastname: Hilton
authors.affiliation: Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK.
authors.forename: B
authors.initials: B
authors.lastname: McGorum
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
authors.forename: E
authors.initials: E
authors.lastname: Davis
authors.affiliation: Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Schoster
authors.affiliation: Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Arroyo
authors.affiliation: Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Herts, UK.
authors.forename: B
authors.initials: B
authors.lastname: Dunkel
authors.affiliation: Philip Leverhulme Equine Hospital, University of Liverpool, Wirral, UK.
authors.forename: H
authors.initials: H
authors.lastname: Carslake
authors.affiliation: Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
authors.forename: R C
authors.initials: RC
authors.lastname: Boston
authors.affiliation: Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
authors.forename: A L
authors.initials: AL
authors.lastname: Johnson
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006734:Horse Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006736:Horses; D008297:Male; D011002:Pleuropneumonia, Contagious / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: alteplase; fibrinolysis; intrapleural; pleuritis