Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study

Carmen Alemán, José M. Porcel, José Alegre, Eva Ruiz, Silvia Bielsa, Jordi Andreu, Maria Deu, Pilar Suñé, Mireia Martínez-Sogués, Iker López, Esther Pallisa, Joan Antoni Schoenenberger, J. Bruno Montoro, Tomás Fernández de Sevilla

Research output: Contribution to journalArticleResearchpeer-review

17 Citations (Scopus)

Abstract

© 2015, Springer Science+Business Media New York. Background: Pleurofibrinolysis has been reported to be potentially beneficial in the management of complicated parapneumonic effusions (CPPE) and empyemas in the adult population. Methods: Prospective, controlled, randomized, and double-blind study, to evaluate intrapleural alteplase 10 mg (initially 20 mg was considered but bleeding events forced dose reduction) versus 100,000 UI urokinase every 24 h for a maximum of 6 days in patients with CPPE or empyemas. The primary aim was to evaluate the success rate of each fibrinolytic agent at 3 and 6 days. Success of therapy was defined as the presence of both clinical and radiological improvement, making additional fibrinolytic doses unnecessary, and eventually leading to resolution. Secondary outcomes included the safety profile of intrapleural fibrinolytics, referral for surgery, length of hospital stay, and mortality. Results: A total of 99 patients were included, of whom 51 received alteplase and 48 urokinase. Success rates for urokinase and alteplase at 3 and 6 days were not significantly different, but when only the subgroup of CPPE was considered, urokinase resulted in a high proportion of cures. There were no differences in mortality or surgical need (overall, 3 %). Five (28 %) patients receiving 20 mg of alteplase and 4 (12 %) receiving 10 mg presented serious bleeding events. Conclusions: If intrapleural fibrinolytics are intended to be used, urokinase may be more effective than alteplase in patients with non-purulent CPPE and have a lower rate of adverse events.
Original languageEnglish
Pages (from-to)993-1000
JournalLung
Volume193
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015

Keywords

  • Empyema
  • Fibrinolytic therapy
  • Parapneumonic pleural effusion

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