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Cardiothoracic Surgery |

Role of Intrapleural Tissue Plasminogen in Management of Complicated Pleural Effusion

Adel Ayed, MBBCh; Derar Shehab, MBBCh
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Kuwait University, Kuwait, Kuwait


Chest. 2013;144(4_MeetingAbstracts):108A. doi:10.1378/chest.1701028
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Abstract

SESSION TITLE: Cardiac and Thoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Evaluate the safety and efficacy of intrapleural tissue plasminogen (TPA) in the treatment of complicated pleural effusion.

METHODS: We prospectively studied 63 patients(34 men and 29 women) with complicated pleural effusion treated at single institution over a 2-year period(2011-2012). The median age of patients was 51 year (range :23 to 72 year). Diagnosis was multiloculated parapneumonic effusion(n=36), tuberculous effusion(n=4), hemothorax related to trauma(n=11) and empyema(n=12).Indications for intrapleural fibrinolysis using actylase or rapilase were persistent radiological evidence of loculations after failing drainage by tube. Pre- and post-TPA imaging studies were reviewed by a radiologist.

RESULTS: Small-bore chest tube was used in 51 patients, tube thoracostomy in 11 and both in 1. Positive gram stain or culture was seen in 34 patients. Resolution of pleural opacity after TPA admnistration was seen in 62(98%) patients. One patient(2%) with empyema was referred for surgery. The average length of hospital stay for the 62 patients was 3-5 days. There was no complication and no mortality related to TPA.

CONCLUSIONS: Intrapleural TPA admnistration is an effective and safe therapy in the treatment of mutiloculated pleural effusion and may decrease the need for surgical intervention.

CLINICAL IMPLICATIONS: Intrapleural fibrinolysis therapy improve fluid drainage in patients with complex pleural effusion.

DISCLOSURE: The following authors have nothing to disclose: Adel Ayed, Derar Shehab

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