Author/year
N
Design
Agents
Imaging
Effusion stage
Quality of evidence
Conclusion
Wait et al. [13]/1997
20
RCT
SK 250,000 u/day vs. VATS
CXR
Fibrino-purulent
Moderate
VATS had ↑ efficacy and ↓ hospital days in complex, loculated effusions
Chin and Lim [10]/1997
52
RCT
SK 250,000 u/day vs. thoracostomy tube alone
CT
All stages
Moderate
SK ↑ drainage volume, but no improvement in morbidity or mortality
Davies et al. [9]/1997
24
RCT
SK 250,000 u/day × 3 days vs. NS
US CXR CT
All stages
Moderate
SK ↑ drainage volume and improved CXR in SK group
Bouros et al. [19]/1999
31
RCT
UK 100,000 u/day × 3 days vs. NS
US CXR CT
Fibrino-purulent, empyema
High
UK ↓ hospital days, ↑ successful drainage (86.5 % vs. 25 %) and ↓ surgery (13.5 % vs. 37.5 %)
Diacon et al. [11]/2004
44
RCT
SK 250,000 u/day vs. NS
US CXR
Fibrino-purulent, empyema
High
SK ↑ “clinical success” (82 % vs. 48 %) and ↓ need for surgery (14 % vs. 32 %)
Misthos et al. [12]/2005
127
RCT
SK 250,000 u/day vs. thoracostomy tube alone
US CXR CT
All stages
High
SK ↑ success (87 % vs. 67 %), ↓ hospital stay and mortality
Maskell et al. [14]/2005 MIST 1 trial
454
RCT, double-blind
SK 250,000 u/day vs. Placebo
CXR
All stages
High
SK does not ↓ need for surgery, hospital stay or mortality; pop. had high % of mature empyemas
Cameron et al. [3]/2009 cochrane review
761
Meta-analysis
SK, UK
Multiple
N/A
High
Fibrinolytics ↓ the requirement for surgical intervention; however results vary
Tuncozger et al. [21]/2011
49
RCT
UK 100,000 u/day × 3 days
US CXR CT
All stages
High
UK ↓ hospital stay (14 vs. 21 days) and need for surgery (29 % vs. 60 %)
Rahman et al. [15]/2011 MIST 2 Trial
210
RCT, double-blind
tPA 10 mg BID, DNase 5 mg BID, tPA/
DNase, placebo
CXR
All stages
High
t-PA + DNase ↑ drainage volume (29 % vs. 17 %), ↓ need for surgery and hospital stay
Ben-Or et al. [17]/2011
118
Retro-spective review
AT 25 mg/day × 1–8 days vs. thoracostomy tube
CXR CT
All stages
High
AT effectively drained effusions (86.4 %) without ↑ morbidity; no benefit to using >2 doses
Thommi et al. [16]/2012
68
RCT, double-blind
AT 25 mg/day × 3 days vs. placebo
CXR CT
All stages
High
AT ↓ need for operation without ↑ morbidity; high percentage of patients crossed over
Janda et al. [4]/2012
801
Meta-analysis
SK, UK, tPA, DNase
Multiple
N/A
High
Fibrinolytics may ↓ the need for surgery in loculated pleural effusions/empyemas
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