VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax

Kumar, Sunil; Rathi, Vinita; Rattan, Amulya; Chaudhary, Swati; Agarwal, Nayan

doi:10.1016/j.injury.2015.02.028

Cited by 25 publications

(18 citation statements)

References 13 publications

(34 reference statements)

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“…Theoretically, this should improve evacuation of retained collections but studies have demonstrated mixed results [13]. Similarly, IPFT when compared to VATS has been shown to be inferior in the management of traumatic retained haemothorax in one study [14], and of similar efficacy in another [13,15]. While a recent meta-analysis concluded that the use of IPFT in traumatic retained haemothorax resulted in 81-92% of patients being discharged without further surgical intervention, the authors acknowledged the limited number and poor quality of studies included [16].…”

Section: Discussionmentioning

confidence: 99%

Intrapleural fibrinolysis in acute non‐traumatic retained haemothorax

Foo

Herre

2021

Respirology Case Reports

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Haemothorax is an accumulation of blood in the pleural space. Retained haemothorax refers to blood that cannot be drained from the pleural cavity and is associated with an increased risk of empyema and fibrothorax often necessitating surgical evacuation. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non‐traumatic retained haemothorax. The first was a 41‐year‐old female with disseminated Candida guilliermondii sepsis and an iatrogenic haemothorax, second was a 48‐year‐old female with transfusion‐dependent acute myeloid leukaemia and spontaneous haemothorax, and the third was a 72‐year‐old female with spontaneous haemothorax from newly diagnosed lung cancer. All patients received one to two doses of intrapleural alteplase without any bleeding complications and resolution of retained haemothorax. This case series demonstrates the successful application and safety of this approach as an alternative to surgery in a well‐resourced environment with close monitoring and ready access to blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Intrapleural fibrinolysis in acute non‐traumatic retained haemothorax

Foo

Herre

2021

Respirology Case Reports

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“…[24][25][26] When compared to other treatment modalities such as thoracoscopic drainage, IPFT has been shown to be at best equally efficacious in draining a RH. 27 Oguzkaya and colleagues demonstrated that videoassisted thoracoscopic surgery (VATS) was superior to IPFT for the management of RH (71% IPFT vs. 94% VATS) in 65 patients, while Kumar et al showed similar success between IPFT and VATS (71% IPFT vs. 72% VATS) in a study of 35 patients with RH. 27,28 Although not dealing specifically with traumatic RH, IPFT effectively treated 91.3% of 46 patients with sizable RH (>1/3 of the hemithorax) after elective lung surgery, with an average of 6.2 days between the original surgery and IPFT initiation.…”

Section: Intra-pleural Fibrinolytic Therapymentioning

confidence: 99%

“…27 Oguzkaya and colleagues demonstrated that video-assisted thoracoscopic surgery (VATS) was superior to IPFT for the management of RH (71% IPFT vs. 94% VATS) in 65 patients, while Kumar et al showed similar success between IPFT and VATS (71% IPFT vs. 72% VATS) in a study of 35 patients with RH. 27,28 Although not dealing specifically with traumatic RH, IPFT effectively treated 91.3% of 46 patients with sizable RH (>1/3 of the hemithorax) after elective lung surgery, with an average of 6.2 days between the original surgery and IPFT initiation. 23 While the literature has yet to adequately characterize the ideal IPFT group, perhaps those with low volume RH or who could not tolerate an operation would be good candidates for IPFT.…”

Section: Managementmentioning

confidence: 99%

Management of post-traumatic retained hemothorax

Bozzay

Bradley

2018

Trauma

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Introduction: Chest injuries occur in a significant portion of trauma patients and hemothorax is a common result. While the initial management of traumatic hemothorax is most commonly treated with tube thoracostomy, the management of retained hemothorax is a subject of debate. Recent literature has proposed different methods for treating or preventing retained hemothorax, yet the approach to this pathology is not straightforward. Methods: The literature was reviewed for relevant studies regarding the prevention and management of post-traumatic retained hemothorax. What follows is a review of the recent literature and an algorithm for the approach to treating a traumatic retained hemothorax. Results: Identifying a traumatic retained hemothorax and preventing subsequent complications such as pneumonia, empyema, and fibrothorax are significant issues faced by surgeons. Studies for preventing retained hemothorax have focused on initial chest tube size, location, and peri-procedural placement conditions, as well as thoracic lavage. Several treatment modalities exist, including second drainage procedure and intra-pleural fibrinolytic drug instillation, but videoassisted thoracoscopic surgery is the most common and successful approach. Regardless of the approach to evacuation, early intervention is paramount. Conclusion: Further studies will help characterize appropriate candidates, timing, treatment modalities, and guide therapy for retained hemothorax.

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“…The use of intrapleural fibrinolysis with streptokinase has been described, and although this method was effective based on surrogate markers of thrombus degradation, it was found to be complicated by the development of antibodies and delayed hypersensitivity reactions. [14][15][16] This led to the development of urokinase, a less antigenic option, which was later taken off the market because of the risk of transmitting viral disease. 17,18 Alteplase avoids the previously described complications.…”

Section: Introductionmentioning

confidence: 99%

Intrapleural Tissue Plasminogen Activator for Traumatic Retained Hemothorax

et al. 2019

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Objective: To describe the efficacy, safety, dosing regimen, and administration technique of intrapleural alteplase for the treatment of retained hemothorax. Data Sources: A PubMed, EMBASE, and Google Scholar search (January 2000 to February 2019) was conducted with the search terms intrapleural, fibrinolytic, fibrinolysis, alteplase, tissue plasminogen activator, and hemothorax. Study Selection and Data Extraction: Articles were included if they described the use of intrapleural alteplase in adult patients with a retained hemothorax; single patient case reports and abstracts were excluded. Data Synthesis: A total of 6 retrospective reviews and 1 meta-analysis were identified for inclusion. A variety of dosing strategies have been defined for the administration of intrapleural alteplase ranging from 6 to 100 mg, volume of fluid from 50 to 120 mL of normal saline, and the number of total doses has ranged from 1 to 8 over the treatment course. A majority of studies showed a greater than 80% success rate and less than 7% bleeding rate. Relevance to Patient Care and Clinical Practice: Because of the paucity of data for use of alteplase in retained hemothorax and administration of a high-risk medication, this review provides dosing and administration recommendations based on reported safety and efficacy. Conclusion: Administration of intrapleural alteplase should be considered in patients with retained hemothorax as an alternative to surgical intervention. In contrast to intrapleural alteplase administration for other indications such as empyema, higher doses and volumes of alteplase are recommended for retained hemothorax.

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VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax

Cited by 25 publications

References 13 publications

Intrapleural fibrinolysis in acute non‐traumatic retained haemothorax

Intrapleural fibrinolysis in acute non‐traumatic retained haemothorax

Management of post-traumatic retained hemothorax

Intrapleural Tissue Plasminogen Activator for Traumatic Retained Hemothorax

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