Effectiveness and Safety of Tissue Plasminogen Activator in the Management of Complicated Parapneumonic Effusions

Weinstein, Michael; Restrepo, Ricardo; Chait, Peter; Connolly, Bairbre; Temple, Michael; Macarthur, Colin

doi:10.1542/peds.113.3.e182

Cited by 49 publications

(49 citation statements)

References 13 publications

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“…One study determined that tPA was also effective and safe in the drainage of complicated pediatric parapneumonic effusions [5]. Based on the results reported in these studies, we studied the clinical efficacy and safety of tissue plasminogen activator (tPA) in the drainage of intra-abdominal abscesses.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and facilitates resolution when used as an adjunct during drainage of intra-abdominal abscesses. Methods: A single-blinded, prospective, multi-center, randomized control trial was performed on patients presenting with image confirmed abscesses; the first group (n = 24) received catheter-directed tPA of their abscess and the second group (n = 23) had their abscess drained without tPA instillation. Variables examined included patient age, gender, location of the abscess, pre-drainage volumes and size of catheters inserted. Baseline variables were compared between tPA and non-tPA groups using a chi-square test for discrete variables and a Wilcoxon rank sum test for continuous variables and for the outcome of drainage volume. Results: Technical success of the drainage procedures was 100% for both groups. The tPA group had higher volume of drainage over the first three days (median for total after 3 days: without tPA: 300 mL vs. with tPA: 322 mL, p = 0.42). At days 4 to 7 the tPA group had significant greater drainage volume than did the non-tPA patient group, 150 mL vs. 110 mL (p = 0.046). The number of days to resume diet was also assessed in the 20 patients where this datum was available, 11 tPA and 9 non-tPA with no difference between groups. No adverse events, such as localized or systemic bleeding were encountered. Conclusion: Instillation of tPA into catheter directed intra-abdominal abscesses was safe, easy to perform and was associated with significantly improved drainage of abscesses from days 4 -7. S. A. Kotecha et al. 203

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Section: Introductionmentioning

confidence: 99%

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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“…Although most studies have used urokinase as a fibrinolytic agent in CTWF, this agent is not currently available in Canada. Therefore, an alternative agent is tissue plasminogen activator (at a dose of 4 mg in 30 mL to 50 mL of normal saline daily for up to three days) (19).…”

Section: Choice Of Procedural Interventionmentioning

confidence: 99%

Paediatric complicated pneumonia: Diagnosis and management of empyema

Chibuk¹,

Cohen²,

Robinson³

et al. 2011

Paediatrics and Child Health

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“…(Alteplase is used in North America for empyema. Evidence is from retrospective reviews [186,187], rather than randomised controlled trials).…”

Section: Intrapleural Drugsmentioning

confidence: 99%

Respiratory medicines for children: current evidence, unlicensed use and research priorities

Smyth¹,

Barbato²,

Beydon³

et al. 2009

Eur Respir J

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This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe offlicence use, research priorities and ongoing studies.Off-licence and off-label prescribing in children is widespread and potentially harmful. Research areas in asthma include novel formulations and regimens, and individualised prescribing. In cystic fibrosis, future studies will focus on screened infants and robust outcome measures are needed. Other areas include new enzyme and antibiotic formulations and the basic defect. Research into pneumonia should include evaluation of new antibacterials and regimens, rapid diagnostic tests and, in pleural infection, antibiotic penetration, fibrinolytics and surveillance. In uncommon conditions, such as primary ciliary dyskinesia, congenital pulmonary abnormalities or neuromuscular disorders, drugs indicated for other conditions (e.g. dornase alfa) are commonly used and trials are needed. In neuromuscular disorders, the b-agonists may enhance muscle strength and are in need of evaluation. Studies of antibiotic prophylaxis, immunoglobulin and antifungal drugs are needed in immune deficiency.We hope that this summary of the evidence for respiratory medicines in children, highlighting gaps and research priorities, will be useful for the pharmaceutical industry, the paediatric committee of the European Medicines Agency, academic investigators and the lay public.

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Effectiveness and Safety of Tissue Plasminogen Activator in the Management of Complicated Parapneumonic Effusions

Cited by 49 publications

References 13 publications

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Paediatric complicated pneumonia: Diagnosis and management of empyema

Respiratory medicines for children: current evidence, unlicensed use and research priorities

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