INTRAPLEURAL FIBRINOLYSIS WITH STREPTOKINASE AS AN ADJUNCTIVE TREATMENT IN HEMOTHORAX AND EMPYEMA - A MULTICENTER TRIAL

To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, a nd multicenter trial among five hospitals in Mexico. We enrolled patie nts with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and an tibiotics in patients with empyema, All patients received repeated dos es of 250,000 IU of streptokinase through chest tube. Effectiveness cr iteria were before and after intrapleural streptokinase (IPSK) drainag e, and poststreptokinase radiographic and respiratory function test im provement, Forty-eight patients were studied; there were 30 patients w ith empyemas, 14 with hemothorax, and 4 patients with malignant pleura l effusions without lung trapping, Successful fibrinolysis was obtaine d in 44 patients, with complete resolution of the pleural collection a nd adequate radiologic and spirometric improvement. In three of four p atients with multiloculated malignant hemothorax with high-yielding pl eural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatme nt. The overall success rate in our series was 92%, similar to previou s reports. The results in this first prospective and multicentric tria l suggest that intrapleural fibrinolysis is an effective and safe adju nctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by r espiratory function tests and can obviate surgery in most cases.