title: Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study.
abstract: BACKGROUND
  Pleurofibrinolysis has been reported to be potentially beneficial in the management of complicated parapneumonic effusions (CPPE) and empyemas in the adult population.
  
  
  METHODS
  Prospective, controlled, randomized, and double-blind study, to evaluate intrapleural alteplase 10 mg (initially 20 mg was considered but bleeding events forced dose reduction) versus 100,000 UI urokinase every 24 h for a maximum of 6 days in patients with CPPE or empyemas. The primary aim was to evaluate the success rate of each fibrinolytic agent at 3 and 6 days. Success of therapy was defined as the presence of both clinical and radiological improvement, making additional fibrinolytic doses unnecessary, and eventually leading to resolution. Secondary outcomes included the safety profile of intrapleural fibrinolytics, referral for surgery, length of hospital stay, and mortality.
  
  
  RESULTS
  A total of 99 patients were included, of whom 51 received alteplase and 48 urokinase. Success rates for urokinase and alteplase at 3 and 6 days were not significantly different, but when only the subgroup of CPPE was considered, urokinase resulted in a high proportion of cures. There were no differences in mortality or surgical need (overall, 3 %). Five (28 %) patients receiving 20 mg of alteplase and 4 (12 %) receiving 10 mg presented serious bleeding events.
  
  
  CONCLUSIONS
  If intrapleural fibrinolytics are intended to be used, urokinase may be more effective than alteplase in patients with non-purulent CPPE and have a lower rate of adverse events.
authors.affiliation: Department of Internal Medicine, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. 29261cal@comb.cat.
authors.forename: Carmen
authors.initials: C
authors.lastname: Alemán
authors.affiliation: Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Porcel
authors.affiliation: Department of Internal Medicine, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Alegre
authors.affiliation: Department of Internal Medicine, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ruiz
authors.affiliation: Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bielsa
authors.affiliation: Department of Radiology, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Andreu
authors.affiliation: Department of Thoracic Surgery, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Deu
authors.affiliation: Department of Pharmacy, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Suñé
authors.affiliation: Department of Pharmacy, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Martínez-Sogués
authors.affiliation: Department of Thoracic Surgery, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Iker
authors.initials: I
authors.lastname: López
authors.affiliation: Department of Radiology, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Pallisa
authors.affiliation: Department of Pharmacy, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain.
authors.forename: Joan Antoni
authors.initials: JA
authors.lastname: Schoenenberger
authors.affiliation: Department of Pharmacy, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bruno Montoro
authors.affiliation: Department of Internal Medicine, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Tomás Fernández
authors.initials: TF
authors.lastname: de Sevilla
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004311:Double-Blind Method; D016724:Empyema, Pleural / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator
keywords: Empyema; Fibrinolytic therapy; Parapneumonic pleural effusion