Retrospective Evaluation of Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa for the Treatment of Traumatic Retained Hemothorax: A 6-Year Experience.

Autor:	Janowak CF; Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Becker BR; IngenioRX, Inc, Morristown, NJ, USA.; Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA., Philpott CD; Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA.; UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA., Makley AT; Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Mueller EW; Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA.; UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA., Droege CA; Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA.; UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA., Droege ME; Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA.; UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2022 Feb 20, pp. 10600280221077383. Date of Electronic Publication: 2022 Feb 20.
DOI:	10.1177/10600280221077383
Abstrakt:	Background: Intrapleural fibrinolytic instillation is second-line treatment for retained hemothorax. Dornase alfa (DNase) has demonstrated efficacy in parapneumonic effusion, but the lack of deoxyribonucleoproteins limits direct extrapolation to traumatic retained hemothorax treatment. Objective: This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax. Methods: This retrospective cohort study included patients aged 16 years and older admitted to a level 1 trauma center from January 2013 through July 2019 with retained hemothorax and one or more intrapleural tPA instillations. Exclusion criteria were tPA for other indications or concomitant empyema. The primary endpoint was treatment failure defined as the need for operative intervention. Results: Fifty patients were included (tPA alone: 28; tPA with DNase: 22). Baseline characteristics were similar between groups, including time to diagnosis (6.5 [interquartile range (IQR), 4-15.5] days vs 6 [IQR, 6.3-10.8] days, P = 0.52). Median tPA dose per treatment (6 [IQR, 6-6.4] mg vs 10 [IQR, 8.4-10] mg, P < 0.001) and cumulative tPA (18 [IQR, 6.5-24] mg vs 30 [IQR, 29.5-40], P < 0.001) dose were significantly lower in the tPA alone group. Treatment failure was similar between groups. Chest tube output, retained hemothorax reduction, and bleeding incidences were similar between groups. Multivariate logistic regression demonstrated no significant risk factors for treatment failure. Conclusions and Relevance: Dornase alfa added to tPA may not reduce the need for operation to treat retained hemothorax. Further studies should be directed at optimal tPA dose determination and economic impact of inappropriate DNase use.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu