To determine if Alteplase can be safely instilled intrapleurally in patients with hemothorax, and who are poor surgical candidates.
Ten patients with hemothorax were evaluated for intrapleural Alteplase instillation. These patients were either postoperative patients or poor surgical candidates with the following characteristics: Three patients had spontaneours hemothoraces secondary to anticoagulation; two patients had thoracotomies with decortication and postoperatively were noted to have large hematomas in the pleural space; five patients with malignant pleural effusions that were frankly bloody with multiple loculations documented on CT scan and/or ultrasound of the chest. Patients were anemic and needed transfusion prior to Alteplase instillation. All patients had 28-F or 30-F chest tube catheter placed without any improvement of the hemothorax. Patients were monitored for at least fourty eight hours prior to Altelplase instillation. Initially, 10 mg of Alteplase was instilled intrapleurally. If no complications occured then further doses of 10 mg to 25 mg of Alteplase was administered daily until significant clearing of the hemothorax was noted. Most patients required three to four doses of Alteplase therapy.
All patients tolerated the procedure well and marked clearing of the hemothorax was noted. No patients needed surgical intervention or any other medical therapy.
Intrapleural instillation of Alteplase can be safely used in patients with hemothorax occuring spontaneously, with malignant pleural effusions, or in postoperative patients, providing no trauma or acute bleeding is noted.
Alteplase is an alternative to surgical intervention in the management of patients with hemothorax.
G. Thommi, Supported by Genetech, Inc