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Adjunctive Intrapleural Tissue Plasminogen Activator Administered via Chest Tubes Placed with Imaging Guidance: Effectiveness and Risk for Hemorrhage
- Source :
- Radiology. 246:956-963
- Publication Year :
- 2008
- Publisher :
- Radiological Society of North America (RSNA), 2008.
-
Abstract
- To retrospectively determine the effectiveness of and risk for hemorrhage with intrapleural adjunctive tissue plasminogen activator (tPA) administered via chest tubes placed with imaging guidance.This HIPAA-compliant study was approved by the institutional review board of Massachusetts General Hospital, with informed consent waived. A retrospective review of 66 patients (age range, 1-95 years; mean age, 55 years; 44 male, 22 female) who received intrapleural tPA between 2000 and 2006 was performed. Overall effectiveness of tPA was defined as successful drainage without need for additional decortication or video-assisted thoracoscopic surgery. Primary and secondary effectiveness were defined as effectiveness after one and two cycles of tPA, respectively. Imaging findings and complications were recorded. Hemorrhagic complications were noted, and the Fisher exact test was used to show whether concurrent systemic anticoagulation increased bleeding risk.Fifty-seven (86%) of 66 patients underwent complete drainage with tPA without further surgical procedures. Primary effectiveness was seen in 52 (87%) of 60 patients and secondary effectiveness was seen in five (83%) of six. Loculation of fluid was the most common finding in this selected cohort. Number of fluid pockets, pleural heterogeneity, and pleural thickness were not predictors of effectiveness. There were five major pleural hemorrhages in four patients across five tPA cycles. Hemorrhages occurred only in patients receiving therapeutic anticoagulation (four of 12) and in none of the other patients (P.001). No hemorrhages occurred in the 38 patients receiving prophylactic anticoagulation.Intrapleural tPA is effective in improving drainage of loculated effusions not drained with catheters alone; prophylactic systemic anticoagulation does not increase bleeding risk with intrapleural tPA, but therapeutic anticoagulation is associated with a significantly increased risk of pleural hemorrhage.
- Subjects :
- Adult
Male
Thorax
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Hemorrhage
Radiography, Interventional
Tissue plasminogen activator
symbols.namesake
Fibrinolytic Agents
Risk Factors
Informed consent
medicine
Humans
Radiology, Nuclear Medicine and imaging
Risk factor
Child
Fisher's exact test
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Anticoagulants
Infant
Retrospective cohort study
Middle Aged
Decortication
Institutional review board
Surgery
Chest Tubes
Child, Preschool
Tissue Plasminogen Activator
symbols
Drainage
Female
Tomography, X-Ray Computed
business
medicine.drug
Subjects
Details
- ISSN :
- 15271315 and 00338419
- Volume :
- 246
- Database :
- OpenAIRE
- Journal :
- Radiology
- Accession number :
- edsair.doi.dedup.....c394545402b743efc1a310e8cbc563bf