Document Detail

Intrapleural hemorrhage after administration of tPA: a case report and review of the literature.
MedLine Citation:
PMID:  19934281     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Intrapleural fibrinolytic enzymes have been used for over 60 years in the treatment of complicated pleural effusions to lyse loculations and promote resolution. Despite this extensive history of use, however, little is known about complications that may arise with the use of this therapy. Here we discuss a patient with chronic renal failure on hemodialysis who developed an intrapleural hemorrhage after the administration of intrapleural tPA to treat a complicated parapneumonic effusion. A review of the literature examines the efficacy and safety of this therapy, focusing on bleeding complications. Specific attention is paid to patients who have underlying coagulopathies or who are receiving anticoagulation. DATA SOURCES: A review of the literature, as indexed in PubMed, was undertaken using the following search terms in combination: tPA, pleural effusion, complications of thrombolytics, and intrapleural hemorrhage. The search was inclusive of patients under the age of 18, but was limited by English language and human subjects. STUDY SELECTION/DATA EXTRACTION: All relevant articles identified during the search were reviewed. Those studies that reported on bleeding complications, or lack thereof, were included in this review. Limitations of each article are noted in the text. CONCLUSIONS: Multiple studies, including a 2000 ACP consensus statement and a 2008 Cochrane review, indicate the need for further investigations to evaluate the safety and efficacy of intrapleural thrombolytics for the treatment of complicated pleural effusions and empyemas. Limited studies specifically address bleeding complications, especially in subpopulations of patients receiving concurrent anticoagulant therapy.
Jennifer L Goralski; Philip A Bromberg; Benjamin Haithcock
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Therapeutic advances in respiratory disease     Volume:  3     ISSN:  1753-4666     ISO Abbreviation:  Ther Adv Respir Dis     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101316317     Medline TA:  Ther Adv Respir Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  295-300     Citation Subset:  IM    
University of North Carolina at Chapel Hill, Division of Pulmonary and Critical Care Medicine, Chapel Hill, NC, USA.
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MeSH Terms
Fibrinolytic Agents / administration & dosage,  adverse effects*,  therapeutic use
Hemothorax / chemically induced*
Instillation, Drug
Kidney Failure, Chronic / therapy
Pleural Cavity
Pleural Effusion / drug therapy
Renal Dialysis
Tissue Plasminogen Activator / administration & dosage,  adverse effects*,  therapeutic use
Reg. No./Substance:
0/Fibrinolytic Agents; EC Plasminogen Activator

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