Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube dra...

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Bibliographic Details
Published in:The Annals of pharmacotherapy 2003-03, Vol.37 (3), p.376-379
Main Authors: Walker, Charlotte A, Shirk, Mary Beth, Tschampel, Marva M, Visconti, James A
Format: Article
Language:English
Subjects:
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Drug Administration Schedule
Fatal Outcome
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Humans
Instillation, Drug
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Pleural Effusion - drug therapy
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
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Summary:OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention. DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE. CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.
ISSN:1060-0280
1542-6270
DOI:10.1345/aph.1C248