Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations

Thomas, Rajesh; Piccolo, Francesco Lo; Miller, Daniel J.; MacEachern, Paul; Chee, Alex; Huseini, Taha; Yarmus, Lonny; Bhatnagar, Rahul; Lee, Hans J.; Feller‐Kopman, David; Maskell, Nick A; Tremblay, Alain; Lee, Y. C. Gary

doi:10.1378/chest.14-2401

Cited by 66 publications

(63 citation statements)

References 22 publications

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“…It is reported to be present in 5–14% of IPC-treated patients, and typically occurs at about 2 months after IPC insertion 79 12 17 48 49 Pleural aspiration, removal of the ineffective IPC and insertion of a second catheter targeting the residual locules can be considered. These strategies necessitate invasive procedures with inherent risks, and the feasibility depends on the locations and sizes of the residual locules 49…”

Section: Introductionmentioning

confidence: 99%

“…This may help to lyse adhesions, restores drainage via IPC and thus avoids a second invasive pleural procedure (figure 2). A recent four-centre retrospective study examined 66 patients with IPC insertion for MPE, who received intrapleural fibrinolytic therapy for symptomatic loculations 48. Symptomatic response and improvement in pleural fluid drainage were achieved in the majority of the patients (83% and 93%, respectively) (figure 2), with corresponding reduction in residual pleural fluid on chest X-ray 48.…”

Section: Introductionmentioning

confidence: 99%

“…A recent four-centre retrospective study examined 66 patients with IPC insertion for MPE, who received intrapleural fibrinolytic therapy for symptomatic loculations 48. Symptomatic response and improvement in pleural fluid drainage were achieved in the majority of the patients (83% and 93%, respectively) (figure 2), with corresponding reduction in residual pleural fluid on chest X-ray 48. Pleural bleeding occurred in two (3%) patients; both responded to supportive blood transfusion without haemodynamic consequences or need of invasive interventions.…”

Section: Introductionmentioning

confidence: 99%

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Complications of indwelling pleural catheter use and their management

2016

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The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complications of indwelling pleural catheter use and their management

2016

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“…A multicentre review of four pleural centres described 66 cases of fibrinolytic therapy given via an IPC for this indication. What was clear was that there is not yet a consensus on how, or indeed whether, treatment should be given to this population [47]. A recently reported randomised controlled trial (RCT), the TIME3 (Third Therapeutic Intervention in Malignant Effusion Trial) study, addressed whether treatment with urokinase via a chest drain could improve pleurodesis efficacy in loculated MPE.…”

Section: Short-term Drainage Proceduresmentioning

confidence: 99%

Advanced medical interventions in pleural disease

et al. 2016

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The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease. @ERSpublications Technological advances and greater availability of techniques give a broad range of interventions for pleural disease http://ow.ly/ZNya2

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“…Heavily septated pleural effusions are unlikely to drain fully, and consequently pleurodesis will be impaired. There were encouraging results initially from an observational trial investigating the use of fibrinolytics to dissolve septations in loculated MPEs [Thomas et al 2015]. However, a subsequent randomized control trial demonstrated that intrapleural urokinase does not improve dyspnoea or pleurodesis success compared with placebo in patients with nondraining MPEs, and therefore urokinase has no routine role in managing this subgroup of patients with MPE [Mishra et al 2016].…”

Section: Chest Drainage and Pleurodesismentioning

confidence: 99%

Current best practice in the evaluation and management of malignant pleural effusions

Walker

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Maskell

2016

Ther Adv Respir Dis

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Malignant pleural effusions (MPEs) are an important cause of cancer-related mortality and morbidity. It is a heterogeneous group of conditions, which leads to debilitating symptoms and confers a poor prognosis. Recent well-designed randomized trials have provided a broader evidence base for an expanding range of treatment options. Together, with new prognostic scoring systems and a greater understanding of how different patient phenotypes respond to treatment, this allows greater personalization of management. This article will discuss the current evidence on evaluation and management of MPEs.

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Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations

Cited by 66 publications

References 22 publications

Complications of indwelling pleural catheter use and their management

Complications of indwelling pleural catheter use and their management

Advanced medical interventions in pleural disease

Current best practice in the evaluation and management of malignant pleural effusions

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