Fibrinolytic Treatment for Pleural Effusion

Abstract

Bacterial pneumonias are frequently associated with pleuropulmonary infections. Although most of these infections are treated with appropriate antibiotic treatment, complicated parapneumonic effusion and empyema represent the two situations where surgical interventions should be considered. In early stages with selected patients and close follow-up, the use of fibrinolytic agents has become a safe treatment modality. These fibrinolytic agents include streptokinase, urokinase and recombinant tissue plasminogen activator (TPA) and are used for the breakdown of the fibrinous tissue where drainage has been ineffective. Deoxyribonuclease is another enzyme used to decrease the viscosity of pleural effusion and promote drainage via chest tubes. Although there are many different studies regarding fibrinolytic treatment with different results, it is generally accepted that in the early stage where antibiotic treatment and chest tube drainage have been unsuccessful and the clinical status and radiology progress, another option should be to lyse the fibrinous bands and increase drainage. This treatment protocol was accepted as C levelbased evidence at the consensus guideline meeting of the Infectious Diseases Society of America (IDSA)/ American Thoracic Society (ATS) where fibrinolytic treatment, videoassisted thoracic surgery (VATS) and surgery were determined to be acceptable strategies with lower mortality rates and no need for secondary intervention for phase 3 and 4 parapneumonic effusions.