Intrapleural Fibrinolysis With Streptokinase as an Adjunctive Treatment in Hemothorax and Empyema

A Multicenter Trial

¹ From the Hospital de Cardiologia, Centro Médico Nacional
² From the Hospital General de Mexico, SSA
³ From the Hospital American British Cowdray
⁴ From the Hospital de Oncologia, Centro Médico Nacional
⁵ From the Cleveland Clinic Foundation
⁶ From the Hospital de Especialidades 71, IMSS, Torreon, Coahuila

To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.

Key Words: empyema • hemothorax • intrapleural fibrinolysis • intrapleural streptokinase • loculated pleural effusion

Submitted on September 25, 1995
Accepted on January 25, 1996

This article has been cited by other articles:

				R. Padman, K. A. King, S. Iqbal, and P. J. Wolfson Parapneumonic Effusion and Empyema in Children: Retrospective Review of the duPont Experience Clinical Pediatrics, July 1, 2007; 46(6): 518 - 522. [Abstract] [PDF]

				R. W. Light Parapneumonic effusions and empyema. Proceedings of the ATS, January 1, 2006; 3(1): 75 - 80. [Abstract] [Full Text] [PDF]

				L. Herrera-Kiengelher, G. Chi-Lem, R. Baez-Saldana, L. Torre-Bouscoulet, J. Regalado-Pineda, M. Lopez-Cervantes, and R. Perez-Padilla Frequency and Correlates of Adverse Events in a Respiratory Diseases Hospital in Mexico City Chest, December 1, 2005; 128(6): 3900 - 3905. [Abstract] [Full Text] [PDF]

				A Medford and N Maskell Pleural effusion Postgrad. Med. J., November 1, 2005; 81(961): 702 - 710. [Abstract] [Full Text] [PDF]

				P. Misthos, E. Sepsas, M. Konstantinou, K. Athanassiadi, I. Skottis, and A. Lioulias Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study Eur. J. Cardiothorac. Surg., October 1, 2005; 28(4): 599 - 603. [Abstract] [Full Text] [PDF]

				A. K. Cangir, C. Yuksel, M. Dakak, E. Ozgencil, O. Genc, and H. Akay Use of intrapleural streptokinase in experimental minimal clotted hemothorax Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 667 - 670. [Abstract] [Full Text] [PDF]

				G. Ekingen, B. H. Guvenc, S. Sozubir, A. Tuzlaci, and U. Senel Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 503 - 507. [Abstract] [Full Text] [PDF]

				P. H. Navsaria, R. J. Vogel, and A. J. Nicol Thoracoscopic evacuation of retained posttraumatic hemothorax Ann. Thorac. Surg., July 1, 2004; 78(1): 282 - 285. [Abstract] [Full Text] [PDF]

				C. Ozcelik, R. Ulku, S. Onat, Z. Ozcelik, I. Inci, and O. Satici Management of postpneumonic empyemas in children Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 1072 - 1078. [Abstract] [Full Text] [PDF]

				C. Ozcelik, I. Inci, O. Nizam, and S. Onat Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas Ann. Thorac. Surg., December 1, 2003; 76(6): 1849 - 1853. [Abstract] [Full Text] [PDF]

				C W H Davies, F V Gleeson, and R J O Davies BTS guidelines for the management of pleural infection Thorax, May 1, 2003; 58(90002): ii18 - 28. [Full Text]

				G Antunes, E Neville, J Duffy, and N Ali BTS guidelines for the management of malignant pleural effusions Thorax, May 1, 2003; 58(90002): ii29 - 38. [Full Text]

				B. Ghaye and R.F. Dondelinger Imaging guided thoracic interventions Eur. Respir. J., March 1, 2001; 17(3): 507 - 528. [Abstract] [Full Text] [PDF]

				C. W. H. Davies, Z. C. Traill, F. V. Gleeson, and R. J. O. Davies Intrapleural Streptokinase in the Management of Malignant Multiloculated Pleural Effusions Chest, March 1, 1999; 115(3): 729 - 733. [Abstract] [Full Text] [PDF]

				P. C. Cassina, M. Hauser, L. Hillejan, D. Greschuchna, and G. Stamatis VIDEO-ASSISTED THORACOSCOPY IN THE TREATMENT OF PLEURAL EMPYEMA: STAGE-BASED MANAGEMENT AND OUTCOME J. Thorac. Cardiovasc. Surg., February 1, 1999; 117(2): 234 - 238. [Abstract] [Full Text] [PDF]

				D. BOUROS, S. SCHIZA, N. TZANAKIS, G. CHALKIADAKIS, J. DROSITIS, and N. SIAFAKAS Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema . A Randomized, Double-Blind Study Am. J. Respir. Crit. Care Med., January 1, 1999; 159(1): 37 - 42. [Abstract] [Full Text]

				C. W. H. DAVIES, S. LOK, and R. J. O. DAVIES The Systemic Fibrinolytic Activity of Intrapleural Streptokinase Am. J. Respir. Crit. Care Med., January 1, 1997; 157(1): 328 - 330. [Abstract] [Full Text]