Intracavitary Urokinase for Enhancement of Percutaneous Abscess Drainage

Haaga, John R.; Nakamoto, Dean A.; Stellato, Thomas A.; Novak, Ronald D.; Gavant, Morris L.; Silverman, Stuart G.; Bellmore, M. C.

doi:10.2214/ajr.174.6.1741681

Cited by 45 publications

(51 citation statements)

References 21 publications

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“…Size dependent doses of urokinase were injected into abscesses at 8 hour intervals for 4 days compared to saline in the placebo group. Length of stay and treatment cost were significantly less with the urokinase group with no difference in tube residence time [2]. The study did not evaluate flow rates per day as our study did and clinical practice of keeping patients within the hospital while having abscess tubes in place has likely changed within the last 15 years.…”

Section: Discussionmentioning

confidence: 85%

“…This also limited our ability to address whether tPA instillation decreased treatment costs. However, a previous phase II study has shown instillation of an intra-cavitary fibrinolytic significantly reduces length of hospital stay and treatment costs [2].…”

Section: Discussionmentioning

confidence: 98%

“…The study sample size was determined based on the results of a prior randomized study that examined use of intracavitary urokinase on length of stay, days of drainage and febrile course [2]. Significant differences in length of stay and cost were observed with 42 patients randomized.…”

Section: Statistical Methods and Definitionsmentioning

confidence: 99%

“…In a randomized study using urokinase to facilitate abscess drainage [2], 12,500 U of urokinase or equiv. of 1 -2.5 mg tPA was used for 1 -5 cm diameter abscesses, 5 -10 cm size, 50,000 U of urokinase or the equivalent of 2 -10 mg of tPA was used and for abscesses > 10 cm 100,000 U of urokinase was used or the equivalent of 4 -20 mg of tPA.…”

Section: Rationale For Tpa Dosementioning

confidence: 99%

“…This study utilized urokinase, not tPA, for intra-abdominal abscesses [2]. The study did not evaluate flow rates per day.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Statistical Methods and Definitionsmentioning

confidence: 99%

Section: Rationale For Tpa Dosementioning

confidence: 99%

“…This study utilized urokinase, not tPA, for intra-abdominal abscesses [2]. The study did not evaluate flow rates per day.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials

Graziani e Sousa,

Godoi,

Florêncio de Mesquita

et al. 2024

World j. surg.

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IntroductionFibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy.MethodsWe searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA).ResultsWe included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD −6.53 days; 95% CI −9.25 to −3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16–302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration.ConclusionIn adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age‐specific treatments and further research, especially in the pediatric population.

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The Role of Interventional Radiology

Wirth

Treitl

2011

Emergency Radiology of the Abdomen

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Intracavitary Urokinase for Enhancement of Percutaneous Abscess Drainage

Abstract: Urokinase injected intracavitarily is an effective technique for shortening the treatment time and improves the clinical course for patients treated with percutaneous drainage techniques.

Cited by 45 publications

References 21 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

Irrigation with fibrinolytic agents versus saline for percutaneous drainage of abdominal abscesses: A meta‐analysis with trial sequential analysis of randomized trials

The Role of Interventional Radiology

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