Treatment with intrapleural streptokinase for coagulated hemothorax after cardiac surgery with cardiopulmonary bypass

Introduction and objectives. Coagulated hemothorax is a complication of car diac surgery with cardiopulmonary bypass. The objective of this study was t o present the authors' experience in the intrapleural infusion of streptoki nase for the treatment of this complication. Methods. From January 1996 to June 1999, nine patients (6 males, 3 females, age range: 1-75 years) were clinically and radiographically diagnosed with coagulated hemothorax after cardiac surgery. All patients were treated wit h intrapleural infusion of streptokinase at a standard dose of 250,000 unit s in adult patients and 12,000 U/kg in pediatric cases, in cases of occlude d chest drainage, the position of the patient was changed and drainage was opened. Results. In all the cases clinical and radiological improvement was observe d and 100 to 200 ml of hemothorax was obtained on drainage. One patient die d of multiorgan failure due to the underlying disease not related to the pr ocedure. No alteration were observed in hematological tests including coagu lation. The other 8 patients were discharged from hospital and remain witho ut pulmonary compromise to date. Conclusion. Treatment of coagulated hemothorax with intrapleural infusion o f streptokinase is a useful procedure and avoid the need for surgical drain age of hemothorax.