| Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. | |
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MedLine Citation:
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PMID: 16537882 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Yasuharu Tokuda; Dai Matsushima; Gerald H Stein; Seishirou Miyagi |
Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: Chest Volume: 129 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-03-15 Completed Date: 2006-04-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 783-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan. tokuyasu@orange.ocn.ne.jp |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Empyema, Pleural / drug therapy*, surgery Fibrinolytic Agents / administration & dosage, therapeutic use* Humans Pleural Effusion / drug therapy*, surgery Randomized Controlled Trials as Topic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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