Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta‐analysis of randomized control trials

Abstract

The present results show that intrapleural fibrinolysis with urokinase may be potentially effective for reducing the need for surgery. Intrapleural fibrinolytic therapy is effective for shortening the lengths of hospital stays without increasing the incidence of severe side effects.

Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study

“…The need for surgical drainage has been considered an important end point in previous studies on pleurofibrinolysis; the latest meta-analyses concluded that fibrinolysis alone may prevent the requirement for surgical intervention [18,19]. What stands out in our study is that only 3 % of CPPE/empyema patients eventually underwent surgical treatment for their pleural infection.…”

“…In the MIST2 study, only the combination of alteplase and streptodornase (DNase) was linked to a greater volume of drained pleural fluid, radiological improvement, and less need for surgical debridement [16]. More recently, however, two meta-analyses, which incorporated both MIST1 and MIST2 studies, concluded that fibrinolytic therapy is potentially beneficial in the management of adult CPPE and empyemas, as it may prevent the need for surgical intervention [17,18].…”

Intrapleural Fibrinolysis in Post-tubercular Loculated Pleural Effusions at a Tertiary-Care Respiratory Center: An Uncontrolled Blinded Before-After Intervention Study

“…[22][23][24] There is a dearth of studies on the use of urokinase for IPFT from developing countries despite its proven efficacy in the management of loculated pleural effusion from developed world. The present study establishes the effectiveness of urokinase as IPFT for loculated pleural effusion in a developing country set up.…”

It is reasonable to recommended intrapleural alteplase for loculated pleural effusions

“…These studies are split between one large trial (N = 454) that concludes that thrombolytics should not be used in the treatment of pleural effusion 1 and several smaller studies (N ≤ 100) in favor of the use of thrombolytics in the treatment of pleural effusion [2][3][4][5][6][7][8][9][10] . There are also three meta-analyses of the randomized, placebo-controlled trials written on this topic, all of which conclude that intrapleural thrombolytics likely reduce the need for surgical intervention in some patients, but that the data are heterogenous [11][12][13] .…”