Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

• Published in: BMC cardiovascular disorders 2020-08, Vol.20 (1), p.392-6, Article 392
• Main Authors: Dybowska, Małgorzata, Szturmowicz, Monika, Opoka, Lucyna, Rudziński, Piotr, Tomkowski, Witold
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allergies; Anti-Bacterial Agents - therapeutic use; Antibiotics; Case Report; Case studies; Complications and side effects; Constrictive pericarditis; Drug therapy; Effusion; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents - administration & dosage; Humans; Hypotension; Male; Middle Aged; Mortality; Patients; Pericardiectomy; Pericarditis; Pericarditis - diagnostic imaging; Pericarditis - drug therapy; Pericarditis - microbiology; Pericarditis, Constrictive - diagnostic imaging; Pericarditis, Constrictive - microbiology; Pericarditis, Constrictive - prevention & control; Pneumonia; Purulent pericarditis; Recombinant proteins; Recombinant Proteins - administration & dosage; Sepsis; Subxiphoid pericardiotomy; Surgical drains; t-Plasminogen activator; Thoracic surgery; Tissue plasminogen activator; Tissue Plasminogen Activator - administration & dosage; Treatment Outcome; Wound drainage
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01674-z

Pericardial constriction is one of the complications of purulent pericarditis (PP). Most difficult to treat, which may develop both in early and in the late period of the disease, resulting in a very poor prognosis. We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA) was used. Management of PP requires a combined surgical and medical approach. The most important is complete drainage of the effusion by subxiphoid pericardiotomy connected with complementary use of broad-spectrum antibiotics. Despite the use of broad- spectrum antibiotics, in some patients a large volume of daily drainage is still present. Constrictive pericarditis as a complication of PP is observed in majority of patients. Intrapericardial administration of fibrinolytic agents, although not strongly recommended, can improve efficacy of antibiotic treatment especially in patients with loculation fluid and can prevent the development of constrictive pericarditis. r-tPA was applied at a dose of 20 mg dissolved in 100 ml of normal saline in a 100 ml syringe, administered by a large pericardial drain (Pezzer drain) installed into the pericardial cavity during pericardioscopy. The tube was closed and re-opened after 24 h. No serious complications, such as bleeding, allergy or hypotension, were noted. We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA), prevented the development of constrictive pericarditis, and increased efficacy of antibiotic treatment without any significant complications.