Fibrinolytics for Managing Pleural Empyema


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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Dec 30, 2016 | Posted by in CARDIOLOGY | Comments Off on Fibrinolytics for Managing Pleural Empyema
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