THE SYSTEMIC FIBRINOLYTIC-ACTIVITY OF INTRAPLEURAL STREPTOKINASE

Intrapleural fibrinolytics probably improve the drainage of loculated pleural effusions and empyemas. Studies of crude indices of systemic c oagulation suggest this effect is accompanied by little systemic fibri nolysis, but few studies have assessed this in detail. This study exam ines the systemic fibrinolytic activity of two intrapleural streptokin ase (IPSK) regimes in detail. Eight patients received a single dose of 250,000 IU IPSK, and a further eight received serial doses of 250,000 IU IPSK every 12 h for 3 d (total dose: 1.5 million IU). Each dose wa s retained in the pleural cavity for 2 h. Venous blood for prothrombin time, activated partial thromboplastin time, thrombin time, fibrinoge n, and D-dimers due to fibrin degradation were measured before any IPS K. These end points were then remeasured 24 h after IPSK in the single -dose group and after 24, 48, and 72 h in the group receiving serial d oses. There were no physiologic or statistical differences in any of t he indices after administration of IPSK. IPSK administered up to a dos e of 1.5 million IU does not cause significant activation systemic fib rinolysis in humans.