Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2022.0168    [Accepted]
Published online March 7, 2024.
INTRAPLEURAL FIBRINOLYSIS WITH UROKINASE VERSUS ALTEPLASE IN COMPLICATED PLEURAL EFFUSIONS AND EMPYEMA: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Sudipt Adhikari, MBBS, MD1, Vikas Marwah, MD1, Robin Choudhary, MD1, IM Pandey, MD1, Tentu Ajai Kumar, MD1, Virender Malik, MD, DNB1, Arpita Pemmaraju, MD1, Shrinath V, MD1, Suraj Kapoor, MD2
1Army Institute of Cardiothoracic Sciences, Pune, India
2Armed Forces Medical College, Pune, India
Correspondence:  Robin Choudhary, Tel: 9673300582, 
Email: robinch19@gmail.com
Received: 10 January 2023   • Revised: 26 March 2023   • Accepted: 27 February 2024
Abstract
Introduction
Intrapleural fibrinolytic therapy is being used as an effective agent since 1949 in managing complicated pleural effusion and empyema. Several agents like streptokinase (STK), urokinase (UK), and recombinant tissue plasminogen activator (rt-PA) are found to effective with variable effectiveness. However, head-to-head controlled trial to compare the efficacy of the most frequently used i.e., UK and rt-PA (alteplase) in managing complicated pleural effusion has rarely been reported.
Method
ology 50 patients were randomized in two intervention groups i.e., UK and rt-PA. The dose of rt-PA was 10 mg, and that of UK was 1.0 lac unit. UK was given thrice daily for two days, followed by clamping to allow the drugs to retain in the pleural space for 2 hrs. rt-PA was instilled in the pleural space twice daily for two days, and the intercostal drainage was clamped for 1 hour.
Results
A total of 50 patients were enrolled for the study out of which84% (n=42) were males and 16 % (n=8) were females. Among them, 30 (60%) patients received UK, and 20 (40%) patients received alteplase as IPFT agents. The of mean changes in the pleural opacity in the UK group was –33.0 % (SD +/- 9.9) and -41.0 % (SD +/- 14.9) in the alteplase group (P-value-0.014). Pain was the most common adverse side effect, occurring in 60% (n=18) of the patients in the UK group and 40% (n=8) in the alteplase group (P-value 0.24) while fever was the second most common side effect. Patient who reported early (within 6 weeks of onset of symptoms) have shown greater response than who reported late for intervention.
Conclusion
IPFT is a safe and effective option in managing complicated pleural effusion or empyema, and newer agents like alteplase have greater efficacy and similar adverse effects effect profile when compared with conventional agents like UK.
Key Words: Complicated Pleural effusion, Empyema, Intrapleural fibrinolysis, Urokinase, Recombinant tissue plasminogen activator (rt-PA), Alteplase
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