Intrapleural tissue plasminogen activator for the treatment of parapneumonic effusion

Pharmacotherapy
Susan E Hamblin, Douglas L Furmanek

Abstract

Intrapleural tissue plasminogen activator (t-PA) has emerged over the past several years as a treatment option for patients with complicated parapneumonic effusion that does not respond to medical management and drainage. Fibrinolytics are thought to dissolve fibrin deposits and loculations within the pleural space, facilitating drainage of the trapped pleural fluid surrounding the lungs. Whereas older fibrinolytics (streptokinase and urokinase) have been studied for intrapleural use with conflicting results, t-PA is currently the agent most commonly used in adults for this indication. However, the literature describing t-PA therapy for complicated parapneumonic effusion and empyema is sparse, and studies have been highly variable in their methods. Several articles report use of this drug at doses ranging from 2-100 mg at daily intervals or more frequently. Surgical treatment options associated with good outcomes are also available to these patients. As a result, the indications for intrapleural t-PA (especially compared with surgical management) in patients with effusions resistant to conventional drainage are not fully clear. The usefulness of t-PA in all patients with resistant parapneumonic effusions or empyema before surgi...Continue Reading

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Citations

Apr 27, 2011·Current Opinion in Pulmonary Medicine·Imran ZahidMarco Scarci
Nov 17, 2012·American Journal of Respiratory and Critical Care Medicine·Tetsuji TakabayashiRobert P Schleimer
Nov 21, 2012·Journal of Pediatric Surgery·Saleem IslamUNKNOWN APSA Outcomes and Clinical Trials Committee, 2011-2012
Jan 7, 2014·Pharmacotherapy·Emily N Israel, Allison B Blackmer
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Dec 7, 2018·American Journal of Rhinology & Allergy·Seung-No HongDong-Young Kim
Apr 23, 2019·The Annals of Pharmacotherapy·Maya R HolsenMolly Thompson
Feb 6, 2021·The Lancet. Respiratory Medicine·Udit ChaddhaNajib M Rahman
Mar 9, 2020·The Journal of Allergy and Clinical Immunology·Tetsuji Takabayashi, Robert P Schleimer

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