Precision-guided, Personalized Intrapleural Fibrinolytic Therapy for Empyema and Complicated Parapneumonic Pleural Effusions: The Case for the Fibrinolytic Potential.

Clinical Pulmonary Medicine
Steven IdellAndrey A Komissarov

Abstract

Complicated pleural effusions and empyema with loculation and failed drainage are common clinical problems. In adults, intrapleural fibrinolytic therapy is commonly used with variable results and therapy remains empiric. Despite the intrapleural use of various plasminogen activators; fibrinolysins, for about sixty years, there is no clear consensus about which agent is most effective. Emerging evidence demonstrates that intrapleural administration of plasminogen activators is subject to rapid inhibition by plasminogen activator inhibitor-1 and that processing of fibrinolysins is importantly influenced by other factors including the levels and quality of pleural fluid DNA. Current therapy for loculation that accompanies pleural infections also includes surgery, which is invasive and for which patient selection can be problematic. Most of the clinical literature published to date has used flat dosing of intrapleural fibrinolytic therapy in all subjects but little is known about how that strategy influences the processing of the administered fibrinolysin or how this influences outcomes. We developed a new test of pleural fluids ex vivo, which is called the Fibrinolytic Potential or FP, in which a dose of a fibrinolysin is added to...Continue Reading

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Citations

Jan 19, 2018·American Journal of Physiology. Lung Cellular and Molecular Physiology·Andrey A KomissarovSteven Idell
Mar 17, 2020·American Journal of Respiratory and Critical Care Medicine·Steven Idell, Y C Gary Lee
Aug 3, 2019·The European Respiratory Journal·José M Porcel
Dec 10, 2020·Pulmonary Therapy·Anand SundaralingamNajib M Rahman
Feb 6, 2021·The Lancet. Respiratory Medicine·Udit ChaddhaNajib M Rahman
May 13, 2021·Respirology Case Reports·Chuan T Foo, Jurgen Herre
Jul 23, 2021·International Journal of General Medicine·Maged HassanJosé M Porcel

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