INTRAPLEURAL UROKINASE IN THE TREATMENT OF COMPLICATED PARAPNEUMONIC PLEURAL EFFUSIONS AND EMPYEMA

Intrapleural urokinase has not been evaluated systemically in terms of efficacy, safety, and cost of treatment in a large series of patients with complicated (parapneumonic) pleural effusions (CPE) and pleural empyemas (PE), Furthermore, the optimal dose and duration of treatment is not known. Twenty consecutive patients with multiloculated parapne umonic effusions (13 with CPE and 7 with PE), in whom a single chest t ube failed to drain the fluid, were studied prospectively, The age of the patients ranged 15-92 yrs (median 51 yrs), Urokinase was administe red intrapleurally, in a low single daily dose of 50,000 U in 100 mL n ormal saline via the chest tube, Previous intrapleural instillation of 100 mt normal saline failed to promote drainage in all patients. Urok inase enhanced drainage in ail patients, Clinical and radiological imp rovement was noted in all but one patient. The mean (SD) volume of flu id significantly increased in the first 24 h post-urokinase (p<0.001), The number of urokinase instillations ranged 3-7 (median 5). Radiolog ical evaluation showed excellent improvement in 13 of the 20 (65%) pat ients, Urokinase was well-tolerated in all patients, The clinical cour se of patients was uneventful at a mean follow-up of 15 months (range 6-30 months) later, Mean total cost of treatment was $530+/-34.6. Our results show that intrapleural instillation of small doses of urokinas e is a cost-effective and safe mode of treatment of complicated pleura l effusions and pleural empyema and could be the fibrinolytic of choic e.