Treatment of loculated pleural effusions with transcatheter intracavitary urokinase

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema

“…Where as streptokinase has been reported to be effective and safe in patients with CPE and PE, urokinase has rarely been evaluated [14][15][16][17][18]. Urokinase is a direct plasminogen activator, which is not antigenic, and the rare reactions observed with it are probably related to contaminants (pyrogens) in the solution [18].…”

“…In 1989, MOULTON et al [14] first reported the application of urokinase in loculated pleural effusions. This technique was further used in other small series [15][16][17][18][19], but the best dose of urokinase, frequency of instillation, and time of initiation of treatment have not yet been adequately determined.…”

“…This technique was further used in other small series [15][16][17][18][19], but the best dose of urokinase, frequency of instillation, and time of initiation of treatment have not yet been adequately determined. The reported doses of urokinase instillations have ranged 80,000-450,000 U, whilst the duration of treatment has ranged 3-8 days [14][15][16][17][18]. Furthermore, instillations have been left in place 1-4 h each and have been repeated at 1-24 h intervals.…”

“…In a few small series, intrapleural administration of urokinase has been shown to be effective in PPE and PE [14][15][16][17][18]. However, its role in terms of efficacy and safety has not been studied systematically and the optimal dose and duration of treatment is not known.…”

The time course of resolution of adhesions during fibrinolytic therapy in tetracycline-induced pleural injury in rabbits

“…fibrinolytic therapy; fibrinolysis; plasminogen activator inhibitor 1; pleural injury; urokinase; tissue plasminogen activator INTRAPLEURAL FIBRINOLYTIC THERAPY (IPFT) activates the endogenous fibrinolytic system, resolving intrapleural adhesions and complex fibrinous deposits that sequester pockets of inflammation loculations, thus improving drainage and clinical outcome, in part by decreasing surgical interventions (10). There are multiple reports of successful (88 -100% efficacy) IPFT in adult (1,7,8,16,17,29,42,47,48,66,67,72) and in pediatric (2,3,6,11,20,40,41,58,59,61,63,67) patients with empyema although outcomes in adult patients are inconsistent in these trials. Thus IPFT represents a less invasive and costly alternative to video-assisted thoracic surgery or other surgical interventions, which demonstrate comparable efficacy (16,44,45,58,60,71) in pediatric practice.…”