Efficacy of intra Pleural streptokinase injection in Post traumatic Clotted Hemothorax

Abstract

Background: Post traumatic clotted hemothorax is a serious problem associated with fluid loculation by fibrous adhesions, trapped lungs and increase the risk of infection and empyema. Intrapleural instillation of streptokinase may dissolve fibrin clots and membranes, break down adhesions and facilitate complete evacuation of residual blood clots and loculated effusions especially if given in the 1 st 7days post trauma. The aim of this study is to evaluate the effect of streptokinase injection as a fibrinolytic drug treating patients with clotted hemothorax within and after 1-week post trauma. Methodology of this study included 60 patients divided rondomly into 2 groups. Group A: include 30 patients with clotted hemothorax receiving streptokinase from 3rd to 7th day post trauma. Group B: include 30 patients with clotted hemothorax receiving streptokinase after 1-week post trauma. Results of this study revealed no difference between both groups regarding age, gender, side of affection or number of SK injection doses. There were a significant reduction in surgical intervention post SK injection (P = 0.004), period between trauma and SK use (P < 0.001) and failure of SK injection (P = 0.002) and total hospital stay (P <0.001) and CT results post SK injection (P = 0.001) in group A against group B. Conclusion:Intrapleural streptokinase injection could be an ideal option for post-traumatic clotted hemothorax before the decision is made to proceed to VATS or thoracotomy especially if given in the 1 st 7 days post trauma.