title: Intrapleural Fibrinolytic Therapy for Residual Coagulated Hemothorax After Lung Surgery.
abstract: BACKGROUND
  Many studies have described the use of intrapleural fibrinolytics for the treatment of complex pleural processes and traumatic hemothorax, but data are scarce regarding their use for hemothorax after lung surgery.
  
  
  OBJECTIVE
  To evaluate the utility of intrapleural fibrinolytic therapy with urokinase for residual coagulated hemothorax (blood clot accumulation in the pleural cavity) after lung surgery.
  
  
  METHODS
  From July 2009 to November 2013, 46 patients (33 males; mean age, 56.9 ± 10.7 years) were treated with intrapleural urokinase (250,000 IU per dose) for residual hemothorax after lung surgery. Complete response was defined as clinical improvement with complete drainage of the retained collection shown by chest X-ray, and partial response as substantial resolution with minimal residual opacity (<25 % of the thorax). Follow-up was at least 30 days.
  
  
  RESULTS
  The procedure was successful in 42 patients (91.3 %), with complete response observed in 35/46 patients (76.1 %) and partial response in 7/46 (15.2 %). These 42 patients did not require re-intervention for fluid accumulation in the pleural cavity. Treatment failed in 4 patients (8.7 %): one developed bronchopleural fistula that later resolved spontaneously and three (6.5 %) required thoracoscopic drainage for pleural cavity fluid accumulation and lung collapse. No patient required thoracotomy for total decortication. Intrapleural urokinase administration was not associated with serious adverse events, including bleeding complications or allergic reactions.
  
  
  CONCLUSIONS
  Intrapleural fibrinolytic agents should be considered a useful therapeutic option for the treatment of postoperative residual hemothorax. This method appears to be safe and effective in >90 % of patients with postoperative hemothorax.
authors.affiliation: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
authors.forename: Dayu
authors.initials: D
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai, 200433, China.
authors.forename: Deping
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai, 200433, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai, 200433, China.
authors.forename: Hongchen
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China. chenxiaofeng0724@sina.com.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Chen
mesh_terms: D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator