Intrapleural Alteplase and Dornase in a Pregnant Woman With Complicated Parapneumonic Effusion

Amariei, D.; Tran, Bich-Chieu; Yao, Roufan; Britt, Edward M.; Holden, V.K.; Sachdeva, Ashutosh; Pickering, E.

doi:10.1016/j.athoracsur.2019.03.023

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…In addition, several factors make intrapleural fibrinolytics attractive for complicated parapneumonic effusion. Those include the lower dose used for intrapleural treatment, short half-life, large molecular size with low systemic absorption, and no reported teratogenic effects on humans [ 7 , 8 ]. However, side effects may be encountered such fever, allergic reactions, chest pain, and increased risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review

Nasralla

Laing

Turner

2021

J Cardiothorac Surg

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The use of intrapleural fibrinolytics for complicated parapneumonic effusion has been shown to be an effective and safe alternative to surgery. However, there is limited evidence about its use during pregnancy. We present a case and a review of the literature of pregnant women who had successful treatment of their complicated parapneumonic effusion with intrapleural fibrinolytics. To our knowledge this is the first review of cases of pregnant women with parapneumonic effusion managed with intrapleural fibrinolytic.

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Section: Discussionmentioning

confidence: 99%

The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review

Nasralla

Laing

Turner

2021

J Cardiothorac Surg

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“…Systemic fibrinolytics have been used in pregnant patients with life-threatening or potentially debilitating conditions such as ischemic stroke, myocardial infarction, and venous thrombotic events, with no apparent increase in complications from that observed in non-pregnant adults ( Leonhardt et al, 2006 ). The few publications available concur that likewise, IPFT is effective and can be safely used in pregnancy, but should be used on a case-by-case basis given the lack of clinical trials and limited data regarding possible fetal complications ( Torbic et al, 2017 ; Dikensoy et al, 2018 ; Amariei et al, 2019 ; Nasralla et al, 2021 ). Thus, we propose that preclinical studies with appropriate animal models can inform the limits of IPFT and enhance the design of clinical trials aimed to improve the treatment of advanced stage empyema in adults.…”

Section: Treatment Of Advanced Stage Empyema In Adults Cannot Be Extrapolated From Pediatric Researchmentioning

confidence: 99%

From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema

et al. 2022

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Empyema, a severe complication of pneumonia, trauma, and surgery is characterized by fibrinopurulent effusions and loculations that can result in lung restriction and resistance to drainage. For decades, efforts have been focused on finding a universal treatment that could be applied to all patients with practice recommendations varying between intrapleural fibrinolytic therapy (IPFT) and surgical drainage. However, despite medical advances, the incidence of empyema has increased, suggesting a gap in our understanding of the pathophysiology of this disease and insufficient crosstalk between clinical practice and preclinical research, which slows the development of innovative, personalized therapies. The recent trend towards less invasive treatments in advanced stage empyema opens new opportunities for pharmacological interventions. Its remarkable efficacy in pediatric empyema makes IPFT the first line treatment. Unfortunately, treatment approaches used in pediatrics cannot be extrapolated to empyema in adults, where there is a high level of failure in IPFT when treating advanced stage disease. The risk of bleeding complications and lack of effective low dose IPFT for patients with contraindications to surgery (up to 30%) promote a debate regarding the choice of fibrinolysin, its dosage and schedule. These challenges, which together with a lack of point of care diagnostics to personalize treatment of empyema, contribute to high (up to 20%) mortality in empyema in adults and should be addressed preclinically using validated animal models. Modern preclinical studies are delivering innovative solutions for evaluation and treatment of empyema in clinical practice: low dose, targeted treatments, novel biomarkers to predict IPFT success or failure, novel delivery methods such as encapsulating fibrinolysin in echogenic liposomal carriers to increase the half-life of plasminogen activator. Translational research focused on understanding the pathophysiological mechanisms that control 1) the transition from acute to advanced-stage, chronic empyema, and 2) differences in outcomes of IPFT between pediatric and adult patients, will identify new molecular targets in empyema. We believe that seamless bidirectional communication between those working at the bedside and the bench would result in novel personalized approaches to improve pharmacological treatment outcomes, thus widening the window for use of IPFT in adult patients with advanced stage empyema.

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Intrapleural Alteplase and Dornase in a Pregnant Woman With Complicated Parapneumonic Effusion

Abstract: The use of intrapleural alteplase and dornase in pregnant patients remains an uncertain practice because bleeding complications in these cases could be devastating. We present a case in which we successfully used a modified protocol safely.

Cited by 2 publications

References 8 publications

The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review

The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review

From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema

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