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Tuberculosis & Respiratory Diseases

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Vol.84 No.2
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Fibrinolysis with Lower Dose Urokinase in Patients with Complicated Parapneumonic Effusion

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2021, v.84 no.2, pp.134-139
https://doi.org/10.4046/trd.2020.0018
Seul Lee (Dong-A University)
Lee Heock (Dong-A University)
Lee Dong Hyun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.)

Roh Mee Sook (Dong-A University)
Son Choohee (Pulmonology Division, Department of Internal Medicine Dong-A University Hospital)
Kim Sung Hyun (Inje University)
Lee Hyun-Kyung (Inje University)

Seul, L. , Lee, H. , Lee, D. H. , Roh, M. S. , Son, C. , Kim, S. H. , Lee, H. , & (2021). Fibrinolysis with Lower Dose Urokinase in Patients with Complicated Parapneumonic Effusion. Tuberculosis & Respiratory Diseases, 84(2), 134-139, https://doi.org/10.4046/trd.2020.0018
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Abstract

Background: Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. Methods: We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. Results: Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. Conclusion: Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.

keywords
Catheters, Empyema, Fibrinolysis, Indwelling, Pleurisy, Pneumonia

Reference

1.

1. Light RW. Parapneumonic effusions and empyema. Clin Chest Med 1985;6:55-62.

2.

2. Kim YJ, Cha SI, Kwon JS, Yoo SS, Jun HJ, Kim EJ, et al. Treatment results and prognostic factors of complicated parapneumonic effusion and empyema. Tuberc Respir Dis 2007;63:24-30.

3.

3. Park JW, You SM, Seol WJ, Paik EK, Lee KH, Seo JB, et al. Efficacy of pigtail catheter drainage in patients with thoracic empyema or complicated parapneumonic effusion. Tuberc Respir Dis 2003;54:219-29.

4.

4. Kim YS, Kim SM, Kim JH, Lee KS, Yang SC, Yoon HJ, et al. The effect of percutaneous pig-tail catheter drainage in the management of lung abscess and empyema. Tuberc Respir Dis 1996;43:571-8.

5.

5. Janda S, Swiston J. Intrapleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis. Chest 2012;142:401-11.

6.

6. Davies HE, Davies RJ, Davies CW; BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii41-53.

7.

7. Light RW, MacGregor MI, Ball WC Jr, Luchsinger PC. Diagnostic significance of pleural fluid pH and PCO2. Chest 1973;64:591-6.

8.

8. Bergh NP, Ekroth R, Larsson S, Nagy P. Intrapleural streptokinase in the treatment of haemothorax and empyema. Scand J Thorac Cardiovasc Surg 1977;11:265-8.

9.

9. Moulton JS, Moore PT, Mencini RA. Treatment of loculated pleural effusions with transcatheter intracavitary urokinase. AJR Am J Roentgenol 1989;153:941-5.

10.

10. Lee KS, Im JG, Kim YH, Hwang SH, Bae WK, Lee BH. Treatment of thoracic multiloculated empyemas with intracavitary urokinase: a prospective study. Radiology 1991;179:771-5.

11.

11. Couser JI Jr, Berley J, Timm EG. Intrapleural urokinase for loculated effusion. Chest 1992;101:1467-9.

12.

12. Cohen ML, Finch IJ. Transcatheter intrapleural urokinase for loculated pleural effusion. Chest 1994;105:1874-6.

13.

13. Pollak JS, Passik CS. Intrapleural urokinase in the treatment of loculated pleural effusions. Chest 1994;105:868-73.

14.

14. Bouros D, Schiza S, Tzanakis N, Drositis J, Siafakas N. Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema. Eur Respir J 1996;9:1656-9.

15.

15. Nie W, Liu Y, Ye J, Shi L, Shao F, Ying K, et al. Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials. Clin Respir J 2014;8:281-91.

16.

16. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.

17.

17. Goralski JL, Bromberg PA, Haithcock B. Intrapleural hemorrhage after administration of tPA: a case report and review of the literature. Ther Adv Respir Dis 2009;3:295-300.

18.

18. Hendaus MA, Abushahin A. Intrapleural hemorrhage due to alteplase use in a 6-year-old boy with pleural effusion. Int J Gen Med 2013;6:233-6.

19.

19. Strange C, Allen ML, Harley R, Lazarchick J, Sahn SA. Intrapleural streptokinase in experimental empyema. Am Rev Respir Dis 1993;147:962-6.

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