Comparison of intrapleural use of urokinase and tissue plasminogen activator/DNAse in pleural infection

Article Article scientifique Article Comparison of intrapleural use of urokinase and tissue plasminogen activator/DNAse in pleural infection eng 2019 author Bedat Benoît 565412 author Plojoux Jérôme Pierre Olivier 503040 author Noel Jade 821194 author Morel Anna Joane 778680 author Worley Jonathan 748533 author Triponez Frédéric 28673 author Karenovics Wolfram 501317 00084-02019 10.1183/23120541.00084-2019 31528637 2312-0541 https://openres.ersjournals.com/content/5/3/00084-2019 Fibrinolysis can be used to improve fluid drainage in pleural infection. Treatment with either urokinase or tissue plasminogen activator (t-PA) in association with DNAse via a chest tube has been effective at reducing the need for surgery. This study is the first to compare the efficacy of these two treatments. We performed a single-centre, controlled, prospective cohort study. All individuals with pleural infection admitted to our hospital between January 2014 and December 2017 who were treated with antibiotics, a chest tube and fibrinolysis were included in this study. The rate of additional procedure requirements (additional chest tube or surgery) after initial fibrinolysis, complications, costs, and radiological and biological outcomes were analysed. Among the 93 patients included in this study, 34% required additional procedures after an initial fibrinolysis, including 21% who received an additional chest tube and 13% who underwent thoracoscopy. The need for additional procedures arose due to presence of multiple pleural collections (p=0.01) and was associated with the use of large-bore drain (p=0.01). The success rate of fibrinolysis was not significantly different between urokinase and t-PA/DNAse (p=0.35). The differences in drainage duration and in length of hospital stay were not significant either (p=0.05 and p=0.12, respectively). Treatment with t-PA/DNAse was cheaper (p=0.04) but was associated with a higher rate of haemothorax (p=0.002). In conclusion, treatment with urokinase is safer and equally effective when compared with treatment with t-PA/DNAse. Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 false 902 Cancer du poumon et mésothéliome pleural malin 944 952 Groupe Gasche-Soccal Paola 958 ERJ Open Research 5 3 a57157f6-bdf5-44dd-9f9f-7052fcb18e60 Article (Published version) Public 00084-2019.pdf 441576 application/pdf CC BY-NC 082748ee-d694-48ae-b91e-2c7d1a19414e Supplemental data Public inline-supplementary-material-1.jpg 120654 image/jpeg openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Comparison of intrapleural use of urokinase and tissue plasminogen activator/DNAse in pleural infection	ERJ Open Research			2019	345	182

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Morel, Anna Joane