Alteplase and DNase for the treatment of pleural empyema in rats

Gehlen, Mario; Fraga, José Carlos Soares de; Amantéa, Sérgio L.; Silveira, Nádya Pesce da; Kulczynski, Jane; Roesch, Eliane Würdig; Portal, Kalyana G.; Sanches, Paulo Roberto Stefani

doi:10.1016/j.pupt.2019.01.001

Cited by 1 publication

(2 citation statements)

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“…Secondary chest tube drainages were less frequent with RTT-UD (4% vs. 15.4%, P = 0.02). Patients in the RTT-UD group had a reduced length of hospital stay (16 [ 12 – 24 ] vs. 23 days [ 18 – 41 ], P<0.001) and a higher total volume of pleural fluid retrieved (1041 mL [513–1600] vs . 1300 mL [655–2312.5]).…”

Section: Resultsmentioning

confidence: 99%

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Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study

et al. 2021

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Introduction Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT). Methods We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire. Results One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P = 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37–0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52–0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02–1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group. Conclusion Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results.

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Section: Resultsmentioning

confidence: 99%

“…It has also been proven that this treatment strategy is highly cost-effective [ 23 ]. Moreover, a combination including DNase was more effective in experimental studies, with a reduction of pleural fluid viscosity and an increased volume of pleural fluid drained [ 24 , 25 ]. These are the reasons why we used this combination with RTT.…”

Section: Discussionmentioning

confidence: 99%