Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis

Respiratory Medicine Case Reports
M FaisalYl Ban Andrea

Abstract

Alteplase and pulmozyme (DNase) administered intrapleurally have revolutionised the management of pleural infection in the last decade. However, the use of intrapleural fibrinolytic has not been well established in high risks patients. Here, we describe 2 patients with high risk of bleeding due to recent surgery who developed empyema; successfully treated with these medications. The first patient was a 36-year-old female post oesophagectomy for oesophageal carcinoma, complicated with anastomotic leak and empyema; and the second patient was a 56-year-old female post percutaneous nephrolithotomy for right obstructive uropathy who developed right-sided empyema. Both patients were treated successfully with 3 doses of intrapleural alteplase 2.5 mg and DNase 5 mg without any major adverse effects. This case report adds to the current literature on the safety of intrapleural fibrinolytics and highlights that lower doses of alteplase in combination with pulmozyme is efficacious and may be considered in high-risk patients.

References

Aug 28, 2010·Thorax·Helen E DaviesUNKNOWN BTS Pleural Disease Guideline Group
Aug 13, 2011·The New England Journal of Medicine·Najib M RahmanRobert J O Davies
Jan 14, 2016·Respiration; International Review of Thoracic Diseases·Hiren J MehtaMichael A Jantz

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Citations

Jul 28, 2020·Respiratory Medicine Case Reports·M FaisalBan Andrea Yl

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Methods Mentioned

BETA
biopsy
lavage

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