Intrapleural Fibrinolytic Therapy for Residual Coagulated Hemothorax After Lung Surgery
Many studies have described the use of intrapleural fibrinolytics for the treatment of complex pleural processes and traumatic hemothorax, but data are scarce regarding their use for hemothorax after lung surgery.
To evaluate the utility of intrapleural fibrinolytic therapy with urokinase for residual coagulated hemothorax (blood clot accumulation in the pleural cavity) after lung surgery.
From July 2009 to November 2013, 46 patients (33 males; mean age, 56.9 ± 10.7 years) were treated with intrapleural urokinase (250,000 IU per dose) for residual hemothorax after lung surgery. Complete response was defined as clinical improvement with complete drainage of the retained collection shown by chest X-ray, and partial response as substantial resolution with minimal residual opacity (<25 % of the thorax). Follow-up was at least 30 days.
The procedure was successful in 42 patients (91.3 %), with complete response observed in 35/46 patients (76.1 %) and partial response in 7/46 (15.2 %). These 42 patients did not require re-intervention for fluid accumulation in the pleural cavity. Treatment failed in 4 patients (8.7 %): one developed bronchopleural fistula that later resolved spontaneously and three (6.5 %) required thoracoscopic drainage for pleural cavity fluid accumulation and lung collapse. No patient required thoracotomy for total decortication. Intrapleural urokinase administration was not associated with serious adverse events, including bleeding complications or allergic reactions.
Intrapleural fibrinolytic agents should be considered a useful therapeutic option for the treatment of postoperative residual hemothorax. This method appears to be safe and effective in >90 % of patients with postoperative hemothorax.
KeywordsUrokinase Streptokinase Bronchopleural Fistula Lung Surgery Fibrinolytic Agent
We are grateful to all the patients who participated in this study. We thank all the staff involved in this study for their enormous efforts in collecting and ensuring the accuracy and completeness of the data. This scientific research project was supported by Huashan Hospital, Fudan University.
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Potential and real conflict of interest
- 23.Richardson JD, Spain DA (2001) Lesiones de pulmón y pleura. In: Mattox KL, Feliciano DV, Moore EE (eds) Trauma, 4 Spanish edn. México, McGraw-Hill Interamericana, pp 559–580Google Scholar