D. Bouros et al., INTRAPLEURAL STREPTOKINASE VERSUS UROKINASE IN THE TREATMENT OF COMPLICATED PARAPNEUMONIC EFFUSIONS - A PROSPECTIVE, DOUBLE-BLIND-STUDY, American journal of respiratory and critical care medicine, 155(1), 1997, pp. 291-295
Citations number
35
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Intrapleural administration of fibrinolytics has been shown in small n
umbers of patients with complicated parapneumonic effusions (CPE) and
pleural empyema to be effective and relatively safe. Although streptok
inase (SK) is recommended as the fibrinolytic of choice, there are no
comparative studies among fibrinolytics. We therefore compared the eff
icacy, safety, and the cost of treatment two of the most used thrombol
ytics, SK and urokinase (UK). Fifty consecutive patients with CPE or e
mpyema were randomly allocated to receive either SK (25 patients) or U
K, in a double-blind fashion. All patients had inadequate drainage thr
ough chest tube (< 70 ml/24 h). Both drugs were diluted in 100 ml norm
al saline and were infused intrapleurally through the chest tube in a
daily dose of 250,000 IU of SK or 100,000 IU of UK. The chest tube was
clamped for 3 h after instillation. Response was assessed by clinical
outcome, fluid drainage, chest radiography, pleural ultrasound, and/o
r computed tomography. Clinical and radiologic improvement was noted i
n all but two patients in each group, who required surgical interventi
on. The mean volume drained during the first 24 h after instillation w
as significantly increased; 380 +/- 99 ml for the SK group (p < 0.001)
and 420.8 +/- 110 ml for the UK group (p < 0.001). The total volume (
mean rt SD) Of fluid drained after treatment was 1,596 +/- 68 mi for t
he SK group, and 1,510 +/- 55 ml for the UK group (p > 0.05). The SK i
nstillations (mean +/- SD) were 6 +/- 2.16 (range, 3 to 10) and those
of UK 5.92 +/- 2.05 (range, 3 to 8). High fever as adverse reaction to
SK was observed in two patients. The total cost of the drug in the UK
group was two times higher than that of SK ($180 +/- 47 for SK and $3
20 +/- 123 for UK). The mean total hospital stay after beginning fibri
nolytic therapy was 11.28 +/- 2.44 d (range, 7 to 15) for the SK group
and 10.48 +/- 2.53 d (range, 6 to 18) for the UK group (p = 0.32). We
conclude that intrapleural SK or UK is an effective adjunct in the ma
nagement of parapneumonic effusions and may reduce the need for surger
y. UK could be the thrombolytic of choice given the potentially danger
ous allergic reactions to SK and relatively little higher cost of UK.