Role of Intrapleural Urokinase in Empyema Thoracis

Intrapleural Fibrinolytic Therapy in Empyema Thoracis: Where are we now and where do we go from here?

“…Even in institutions where empyema is managed in/by surgical units, fibrinolytic therapy may be a safer, cheaper, logistically easier (hence preferable) option to surgical management at presentation [10,11]. Traditionally, streptokinase has been the fibrinolytic of choice; this study [9] shows that urokinase is also feasible.…”

“…What does this study [9] add to the evidence base? On the one hand, it re-confirms the efficacy and safety of intrapleural fibrinolytic therapy in childhood empyema.…”

“…This issue of the journal has a study evaluating the efficacy and safety of intrapleural urokinase in empyema [9]. The study was a retrospective record review over 4 consecutive years, comparing children who received 6 doses of intrapleural urokinase, vs. those who did not.…”

“…On the one hand, it re-confirms the efficacy and safety of intrapleural fibrinolytic therapy in childhood empyema. Further, to the best of my knowledge, this [9] is the first Indian study evaluating urokinase, although this has been used in several studies in developed countries. In the latter settings, urokinase, alteplase and tissue plasminogen activator are preferred over streptokinase because of the fear of adverse effects and immunological reactions with streptokinase.…”

“…Being a retrospective analysis of previously treated patients, this study [9] had the usual limitations of unstandardized definitions, treatment protocols, and data recording. The main flaw is that the basis for administering urokinase was not uniform in all patients.…”