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

Shawyer, Anna C.; Amaral, João; Langer, Jacob C.

doi:10.1016/j.jpedsurg.2011.12.006

Cited by 10 publications

(8 citation statements)

References 48 publications

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“…In a rat model of intra-peritoneal abscess [8], and empyemas [9] tPA has been shown to be effective in improving drainage of abscesses. A recent retrospective review in children with thick or septated intra-abdominal abscess demonstrated that tPA was safe in their management and possibly reduced hospital stay [10].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and facilitates resolution when used as an adjunct during drainage of intra-abdominal abscesses. Methods: A single-blinded, prospective, multi-center, randomized control trial was performed on patients presenting with image confirmed abscesses; the first group (n = 24) received catheter-directed tPA of their abscess and the second group (n = 23) had their abscess drained without tPA instillation. Variables examined included patient age, gender, location of the abscess, pre-drainage volumes and size of catheters inserted. Baseline variables were compared between tPA and non-tPA groups using a chi-square test for discrete variables and a Wilcoxon rank sum test for continuous variables and for the outcome of drainage volume. Results: Technical success of the drainage procedures was 100% for both groups. The tPA group had higher volume of drainage over the first three days (median for total after 3 days: without tPA: 300 mL vs. with tPA: 322 mL, p = 0.42). At days 4 to 7 the tPA group had significant greater drainage volume than did the non-tPA patient group, 150 mL vs. 110 mL (p = 0.046). The number of days to resume diet was also assessed in the 20 patients where this datum was available, 11 tPA and 9 non-tPA with no difference between groups. No adverse events, such as localized or systemic bleeding were encountered. Conclusion: Instillation of tPA into catheter directed intra-abdominal abscesses was safe, easy to perform and was associated with significantly improved drainage of abscesses from days 4 -7. S. A. Kotecha et al. 203

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Section: Discussionmentioning

confidence: 99%

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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“…13 However, when administration of tPA has been limited to loculated/complex abscesses which fail initial drainage, good effect and improved resolution has been found by others. 4,8 In select cases with complex collections which fail to drain effectively without any fibinrolytic, tPA may still have a beneficial role (Table 4). The current practice in this institution is to use tPA when the sonographic appearance shows residual abscess contents which have failed to drain with saline flushes.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Untreated, an abscess may rupture or progress to full-blown sepsis-a potentially life-threatening and sometimes fatal condition. 4 Image-guided drainage has been an accepted treatment for years, 1,[5][6][7] but may be less effective when collections are complex, septated, or the fluid present is thick. Use of fibrinolytics in intra-abdominal collections has been associated with shorter drainage times and hospital stays, and improved abscess resolution in adults.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] Its use on an ''as-needed'' basis in the management of septated intra-abdominal abscesses in children has been shown to be safe. 4 There is no consensus on optimum tPA regimens in abdominal abscesses, in adults or children. 8,14,15 The purpose of this study was to establish the efficacy of once-per-day intracavitary tPA in the treatment of pediatric intra-abdominal abscesses.…”

Section: Introductionmentioning

confidence: 99%

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Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children—A Single-Center Randomized Control Trial

et al. 2020

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Purpose: To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses. Methods: A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs). Results: Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group ( P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains ( P = .14), drain size ( P = .19), primary outcome ( P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA. Conclusion: No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.

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“…Tissue plasminogen activator has been successfully used to break viscous pus and facilitate drainage of complex parapneumonic empyema in pediatric population [19]. It has been used to facilitate drainage of abdominal abscess in neonatal, pediatric, and adult patients [20, 21]. Criteria for using tPA in parapneumonic effusion include viscous contents with little or no drainage at immediately postdrainage imaging or macroscopically purulent fluid at initial drainage [22].…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Tissue Plasminogen Activator in an Adolescent Male with Pyogenic Liver Abscess

Zee-Cheng

Fox

Patel

et al. 2019

Case Reports in Critical Care

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Large pyogenic liver abscess is a rare and difficult to treat entity in pediatric patients. Percutaneous drainage rather than open surgical drainage has become more common in recent years, even for large abscesses. Percutaneous drainage can be complicated by catheter obstruction. We present the case of a 16-year-old male presenting with abdominal pain, fever, and chills. He was diagnosed with a 9-centimeter liver abscess. A CT-guided percutaneous drainage was placed. The catheter initially drained well, but then became occluded. Tissue plasminogen activator was instilled into the catheter every 6 hours for a total of five doses, resulting in increased drainage and improved clinical state of the patient. To our knowledge, this is the first reported use of tissue plasminogen activator in pyogenic liver abscess in the pediatric population.

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

Cited by 10 publications

References 48 publications

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children—A Single-Center Randomized Control Trial

Successful Use of Tissue Plasminogen Activator in an Adolescent Male with Pyogenic Liver Abscess

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