Intrapleural Instillation of Streptokinase Effects on Systemic Fibrinolysis

Berglin, E; Ekroth, Rolf; Ac, Teger-Nilsson; William-Olsson, G

doi:10.1055/s-2007-1023459

Cited by 73 publications

(26 citation statements)

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“…Our observations are in accord with those in previous reports. Berglin and coworkers (33) did not observe any effects on systemic fibrinolytic activity, ␤ 2 -macroglobulin levels, or thrombin times with the intrapleural instillation of SK in 10 consecutive patients with empyemas or hemothoraces. In addition, they reported a slight increase in plasminogen, ␤ 2 -antiplasmin levels, and fibrinogen, but these alterations probably represented an acute-phase reaction.…”

Section: Discussionmentioning

confidence: 89%

Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema

Bouros

Schiza

Tzanakis

et al. 1999

Am J Respir Crit Care Med

229

177

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Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic pleural effusions. However, controlled studies of the possible role of the activity of urokinase (UK) through the volume effect are lacking. We therefore investigated the hypothesis that UK is effective through the lysis of pleural adhesions and not through the volume effect. Thirty-one consecutive patients with multiloculated pleural effusions were randomly assigned to receive either intrapleural UK (15 patients) or normal saline (NS) (16 patients) for 3 d, in a double-blind manner. All patients had inadequate drainage through a chest tube (< 70 ml/24 h). UK was given daily through the chest tube in a dose of 100.000 IU diluted in 100 ml of NS. Controls were given the same volume of NS intrapleurally. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasonography (US) and/or computed tomography (CT). Clinical and radiographic improvement was noted in all but two patients in the UK group but in only four in the control group. The net mean volume drained during the 3-d treatment period was significantly greater in the UK group (970 +/- 75 ml versus 280 +/- 55 ml, p < 0.001). Pleural fluid drainage was complete in 13 (86.5%) patients in the UK group (two patients were treated through video-assisted thoracoscopy) but in only four (25%) in the control group. Twelve patients in the control group were subsequently treated with UK and six of them had complete drainage; the remaining six patients had complete drainage after video-assisted thoracoscopy. Our results suggest that UK is effective in the treatment of loculated pleural effusions through the lysis of pleural adhesions and not through the volume effect.

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Section: Discussionmentioning

confidence: 89%

Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema

Bouros

Schiza

Tzanakis

et al. 1999

Am J Respir Crit Care Med

229

177

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“…[46]). However, TEMES et al [42] in their series observed a case of significant local bleeding which required thoracotomy.…”

Section: Fibrinolytic Agentsmentioning

confidence: 99%

Parapneumonic effusion and empyema

Hamm

Light²

1997

Eur Respir J

233

150

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Parapneumonic effusions account for about one third of all pleural effusions. Approximately 40% of patients with pneumonia develop a concomitant effusion, which is associated with an increased morbidity and mortality.In order to select the most appropriate therapy for the individual patient, the effusion should be categorized as being in the exudative, fibropurulent, or organizational stage, and all necessary information should be compiled to decide whether the effusion is likely to take an uncomplicated or a complicated course. There is a considerable variation in the aggressiveness and course of parapneumonic effusions, and, therefore, the spectrum of the appropriate therapy may vary from a conservative approach in uncomplicated effusions to aggressive surgical intervention in advanced multiloculated empyemas. This review discusses current diagnostic and therapeutic options and offers guidelines for treating the various stages of parapneumonic effusions and empyemas. Eur Respir J 1997; 10: 1150-1156 Definitions "Pleurisy" (syn. pleuritis) is best defined as an inflammatory process of the pleura, which can be caused either by a variety of infectious microorganisms or by other inflammatory mechanisms. It is usually associated with localized chest pain that is synchronous with the respiratory cycle and is often manifested as a pleural rub on auscultation. It may induce an exudative pleural effusion. The pain and the rub sometimes subside when an effusion develops.A "parapneumonic effusion" is an accumulation of exudative pleural fluid associated with an ipsilateral pulmonary infection."Uncomplicated parapneumonic effusions" are not infected and do not usually need tube thoracostomy."Complicated parapneumonic effusions" are usually associated with the pleural invasion of the infectious agent and require tube thoracostomy and sometimes decortication for their resolution.An effusion is called an "empyema" when the concentration of leucocytes becomes macroscopically evident as a thick and turbid fluid (pus). In more than 50% of cases, it is of parapneumonic origin. Other common causes include surgical procedures (mainly thoracic surgery), traumas and oesophageal perforation. PathophysiologyParapneumonic effusions and empyemas usually develop along the following lines. The pleuritis sicca stageThe inflammatory process of the pulmonary parenchyma extends to the visceral pleura, causing a local pleuritic reaction. This leads to a pleural rub and the characteristic pleuritic chest pain, which originates from the sensitive innervation of the adjacent parietal pleura. A significant number of patients with pneumonia report pleuritic chest pain without developing a pleural effusion [1], suggesting that the involvement of the pleura may be limited to this stage in many cases of pneumonia. The exudative stageThe ongoing inflammatory process leads to a mediator-induced increased permeability of local tissue and of regional capillaries. The subsequent accumulation of fluid in the pleural space is probably the combined ...

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“…Activation of plasmin triggers a proteolysis cascade that degrades the fibrin in the abscess [12,16]. Another fibrinolytic agent, streptokinase, has been used to treat pleural empyema with satisfactory results [27][28][29], but its antigenic blockage effect is a great disadvantage, in spite of its favorable cost compared to urokinase [15]. Intracavitary urokinase (pleural cavity and abscessed cavities) does not have systemic effects [12].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of intrabdominal abscess: urokinase versus saline serum in 100 cases using two surgical scoring systems in a randomized trial

et al. 2009

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The purpose of this study was to assess whether regular instillation of urokinase during abscess drainage leads to an improved outcome compared to saline irrigation alone. One hundred patients referred for image-guided abdominal abscess drainage were randomized between thrice daily urokinase instillation or saline irrigation alone. At the end of the study, patient medical records were reviewed to determine drainage, study group, Altona (PIA II) and Mannheim (MPI) scoring, duration of drainage, procedure-related complications, hospital stay duration, and clinical outcome. The technical success rate of the percutaneous abscess drainage was 100%. The success or failure of abscess remission did not differ significantly between groups (success rate of 91.5% in the urokinase group vs. 88.8% in the saline group; failure rate was of 8.5 vs. 21.2%, respectively); however, days of drainage, main hospital stay, and overall costs were significantly reduced in patients treated with urokinase compared to the control group (P < 0.05). No adverse effects from urokinase were observed. Surgical scores were a useful homogeneity factor, and MPI showed a good correlation with prognosis, while PIA results did not have a significant correlation. For drainage of complex abscesses (loculations, hemorrhage, viscous material), fibrinolytics safely accelerate drainage and recovery, reducing the length of the hospital stay and, therefore, the total cost.

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Intrapleural Instillation of Streptokinase Effects on Systemic Fibrinolysis

Cited by 73 publications

References 1 publication

Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema

Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema

Parapneumonic effusion and empyema

Percutaneous treatment of intrabdominal abscess: urokinase versus saline serum in 100 cases using two surgical scoring systems in a randomized trial

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