A systematic review of the efficacy and safety of intrapericardial fibrinolysis in patients with pericardial effusion

Wiyeh, Alison B.; Ochodo, Eleanor; Wiysonge, Charles Shey; Kakia, Aloysious; Awotedu, A A; Ristić, Arsen; Mayosi, Bongani M.

doi:10.1016/j.ijcard.2017.10.049

Cited by 27 publications

(21 citation statements)

References 8 publications

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“…In comparison to the above mentioned data from the literature [2,4], the efficacy of intrapericardial r-tPA, reported in the present case series was non-inferior to SK. Nevertheless it is difficult to compare these data, due to a small number of patients, as well as different indications for IFT.…”

contrasting

confidence: 57%

“…The clinical experience with IFT has been summarized by Augustin et al in 2011 [2] and recently by Wiyeh et al [4]. Majority of the patients have been treated with intrapericardial streptokinase (SK) [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…Despite proper multidirectional treatment, PP still has a 20-30% mortality rate [2]. In the early stage of the disease, mortality is caused by cardiac tamponade and/or septic shock [3][4][5][6]. Late mortality in the course of PP is combined with pericardial constriction [2].…”

Section: Introductionmentioning

confidence: 99%

“…Purulent pericarditis (PP) is a rare cause of pericardial disease, with the prevalence of less than 3%, but with potentially life-threatening complication [ 1 ]. Most frequently PP develops in the course of bacterial infections of the head, neck or respiratory tract, especially in immunocompromised hosts [ 2 – 4 ]. The other risk factors are chest surgery or injuries [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

Dybowska¹,

Szturmowicz²,

Opoka³

et al. 2020

BMC Cardiovasc Disord

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Background: Pericardial constriction is one of the complications of purulent pericarditis (PP). Most difficult to treat, which may develop both in early and in the late period of the disease, resulting in a very poor prognosis. Case presentation: We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA) was used. Management of PP requires a combined surgical and medical approach. The most important is complete drainage of the effusion by subxiphoid pericardiotomy connected with complementary use of broad-spectrum antibiotics. Despite the use of broad-spectrum antibiotics, in some patients a large volume of daily drainage is still present. Constrictive pericarditis as a complication of PP is observed in majority of patients. Intrapericardial administration of fibrinolytic agents, although not strongly recommended, can improve efficacy of antibiotic treatment especially in patients with loculation fluid and can prevent the development of constrictive pericarditis. r-tPA was applied at a dose of 20 mg dissolved in 100 ml of normal saline in a 100 ml syringe, administered by a large pericardial drain (Pezzer drain) installed into the pericardial cavity during pericardioscopy. The tube was closed and reopened after 24 h. No serious complications, such as bleeding, allergy or hypotension, were noted. Conclusion: We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA), prevented the development of constrictive pericarditis, and increased efficacy of antibiotic treatment without any significant complications.

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contrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

Dybowska¹,

Szturmowicz²,

Opoka³

et al. 2020

BMC Cardiovasc Disord

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“…На фоне лечения, несмотря на тяжелое состояние пациента и наличие сепсиса, признаков портальной гипертензии, двустороннего плеврита и анемии при выраженной гиперкоагуляции и множественных фокусов венозного тромбоза, со-стояние больного значительно улучшилось, практически прекратилось отделяемое по дренажу при отсутствии скоплений экссудата, видимых при УЗИ. А. В. Wiyeh et al, проанализировавшие сообщения о 109 пациентах, которым был проведен внутриперикардиальный фибринолиз, также продемонстрировали хороший профилактический эффект данной методики при отсутствии летальных исходов среди обследованных [22].…”

Section: кг органов грудной клетки у пациентки со злокачественным новunclassified

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

et al. 2019

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Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

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Intensivtherapie bei akuter Herzinsuffizienz, kardiogenem Schock und Herzbeuteltamponade

Iken,

Calineata,

Reyher

et al. 2023

Die Intensivmedizin

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A systematic review of the efficacy and safety of intrapericardial fibrinolysis in patients with pericardial effusion

Cited by 27 publications

References 8 publications

Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

Intensivtherapie bei akuter Herzinsuffizienz, kardiogenem Schock und Herzbeuteltamponade

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