Document Detail

Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis.
MedLine Citation:
PMID:  16537882     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Randomized controlled trials have shown conflicting findings about the role of intrapleural fibrinolytic therapy for the treatment of empyema and complicated parapneumonic effusions in adult patients. OBJECTIVES: To assess the clinical efficacy and summarize the current evidence of intrapleural fibrinolytic use in patients with empyema and complicated parapneumonic effusions in adult patients. METHODS: We performed a meta-analysis of all properly randomized trials comparing intrapleural fibrinolytic agents with placebo in adult patients with empyema and complicated parapneumonic effusions. Outcome of primary interest was the reduction of death and surgical intervention. RESULTS: We included five trials totaling 575 patients. The number of enrolled patients for each trial was small, except for the recent trial by Multicenter Intrapleural Sepsis Trial (MIST1) group. Compared with placebo, intrapleural fibrinolytic therapy was associated with a nonsignificant reduction in death and need for surgery (27.6% of the treatment group vs 32.8% of the control group; random-effects pooled risk ratio, 0.55; 95% confidence interval, 0.28 to 1.07; heterogeneity, p = 0.023). A separate analysis for outcomes on either death or need for surgery also showed nonsignificant results. CONCLUSION: Our meta-analysis does not support the routine use of fibrinolytic therapy for all patients who require chest tube drainage for empyema or complicated parapneumonic effusions. However, there was significant heterogeneity of the treatment effects among the trials. Selected patients might benefit from the treatment.
Yasuharu Tokuda; Dai Matsushima; Gerald H Stein; Seishirou Miyagi
Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Chest     Volume:  129     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-03-15     Completed Date:  2006-04-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  783-90     Citation Subset:  AIM; IM    
Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan.
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MeSH Terms
Empyema, Pleural / drug therapy*,  surgery
Fibrinolytic Agents / administration & dosage,  therapeutic use*
Pleural Effusion / drug therapy*,  surgery
Randomized Controlled Trials as Topic
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents

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