Tenecteplase for Malignant Pericardial Effusion

Abstract

Pericardial effusions may necessitate placement of a catheter into the pericardial space for continuous drainage. If the effusion material is fibrinous or loculated, drainage may slow or cease over time, allowing reaccumulation. Limited data exist to guide the selection of a fibrinolytic agent and the most appropriate dose. We report the case of a 79-year-old woman with malignant pericardial effusion who responded to intrapericardial administration of tenecteplase to facilitate drainage. The patient received three doses of tenecteplase--15 mg, 7.5 mg, and 7.5 mg--over 3 days, resulting in significant drainage. No adverse effects were noted except for a transient episode of hemodynamically stable atrial fibrillation. Use of fibrinolytic agents to facilitate pericardial drainage may offset the need to repeatedly replace the catheter if flow subsides despite continued presence of fluid in the pericardial space.

Intrapericardial Fibrinolytic Therapy in Purulent Pericarditis: A Review of Two Cases

“…Data on the use of r-tPA is limited to a few case reports. Multiple authors have used various agents at various doses [ 6 , 7 , 9 , 10 ]. In each of these cases, the trigger to initiate fibrinolysis was inadequate fluid drainage and/or lack of clinical improvement.…”

“…In each case, r-tPA led to enhanced drainage with clinical improvement. No adverse effects were noted except in the study by Johnson et al, where a transient episode of hemodynamically stable atrial fibrillation was noted - which was considered unrelated to r-tPA and likely due to irritation of the atrial wall by the catheter during injection [ 9 ]. Both of our patients had inadequate drainage from the pericardial drains, and r-tPA was used due to presence of loculations.…”

The role of tissue plasminogen activator in the management of complex intra-abdominal abscesses in children

“…However, many authors have now described the use of fibrinolytic agents for the treatment of extravascular conditions such as empyema, purulent pericarditis, and peritoneal catheter-related peritonitis [9][10][11][12][13]. Although most of this experience has been in adults, multiple studies have now documented their use in children [14][15][16][17][18].…”