Safety and efficacy of tissue plasminogen activator and DNase for complicated pleural effusions secondary to abdominal pathology

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dc.contributor.authorMajid, Adnan
dc.contributor.authorOchoa, Sebastián
dc.contributor.authorChatterji, Sumit
dc.contributor.authorFernández‐Bussy, Sebastián
dc.contributor.authorKheir, Fayez
dc.contributor.authorRivera, Estefania
dc.contributor.authorCheng, George
dc.contributor.authorFolch, Erik
dc.date.accessioned2017-08-28T18:44:35Z
dc.date.available2017-08-28T18:44:35Z
dc.date.issued2017
dc.description.abstractRATIONALE: Exudative pleural effusions may arise secondary to inflammation of intra-abdominal structures. Pleural space loculations can complicate these effusions, preventing adequate chest tube drainage and leading to consideration of surgical intervention. Previous studies have demonstrated that intrapleural administration of tissue plasminogen activator (tPA) combined with human recombinant DNase can improve fluid drainage and reduce surgery for patients with loculated parapneumonic effusions; however, the efficacy of this treatment has not been evaluated for complicated pleural effusions attributed to intra-abdominal inflammation. OBJECTIVES: We assessed the safety and efficacy of tPA/DNase for 17 pleural effusions associated with nonmalignant intra-abdominal pathology that did not drain adequately after placement of one or more chest tubes. METHODS: Efficacy was measured by comparing post- to pretreatment fluid drainage rates, volumetric assessment of pleural fluid on radiographic images before and after treatment, and clinical improvement, including the need for surgical intervention. Symptomatic relief was assessed using the Borg scale for breathlessness. MEASUREMENTS AND MAIN RESULTS: After a median of two doses of tPA/DNase, 23.5% of patients had chest pain and none had pleural bleeding. The volume of pleural fluid drained increased from a median of 325 ml to 890 ml per 24 hours after therapy (P = 0.018). The area of pleural space opacity on chest radiographs decreased from a median of 42.8-17.8% of the hemithorax (P = 0.001). tPA/DNase reduced the pleural fluid volume on chest computed tomographic imaging from a median of 294.4 ml to 116.1 ml. Borg scores improved from a median of 3 (interquartile range = 1-6) to 0 (interquartile range = 0-2) after therapy (P = 0.001). The median duration of chest tube placement and hospital stay were 4 and 11 days, respectively. Two patients required surgical intervention for lung entrapment. Overall, treatment was considered successful for 88.2% of patients. CONCLUSIONS: This retrospective case series suggests that intrapleural tPA/DNase can be safe and effective for patients with complicated pleural effusions attributed to abdominal pathology that do not drain adequately after chest tube placement. Additional studies are needed to determine whether the combination of tPA and DNase is more effective than tPA for this indication
dc.description.versionVersión Publicada
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dc.identifier.citationBussy S, Kheir F, Rivera E, Cheng G, Folch E. Safety and Efficacy of Tissue Plasminogen Activator and DNase for Complicated Pleural Effusions Secondary to Abdominal Pathology. Ann Am Thorac Soc. 2017 Mar;14(3):342-346. doi: 10.1513/AnnalsATS.201608-594BC.
dc.identifier.urihttp://hdl.handle.net/11447/1608
dc.identifier.urihttp://dx.doi.org/10.1513/AnnalsATS.201608-594BC
dc.language.isoen_US
dc.publisherAmerican Thoracic Society
dc.sourceAnnals of the American Thoracic Society
dc.subjectDNase
dc.subjectcomplicated pleural effusion
dc.subjectpleural effusion secondary to abdominal pathology
dc.subjectsympathetic pleural effusion
dc.subjecttissue plasminogen activator
dc.titleSafety and efficacy of tissue plasminogen activator and DNase for complicated pleural effusions secondary to abdominal pathology
dc.typeArtículo

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