Safety and efficacy of reduced dose intrapleural alteplase and DNAase for pleural infection
| Autor: | Deirdre Wallace, Farinaz Noorzad, Hugh Ip, Alex West, Liju Ahmed |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Blood transfusion
medicine.diagnostic_test business.industry medicine.medical_treatment Cancer Dornase alfa medicine.disease Tissue plasminogen activator Sepsis 03 medical and health sciences 0302 clinical medicine 030228 respiratory system 030220 oncology & carcinogenesis Anesthesia Fibrinolysis medicine Thoracoscopy business Prospective cohort study medicine.drug |
| Zdroj: | Respiratory infections. |
| DOI: | 10.1183/13993003.congress-2018.pa4712 |
| Popis: | Introduction: The efficacy of intrapleural alteplase 10mg and dornase alfa (DNase) 5mg in pleural infection was established in the MIST-2 trial. Popowicz N et al suggested that alteplase could be reduced to 5mg (1). Aims and Objectives: To assess the efficacy and safety of 2.5mg of alteplase with 5mg DNase. Methods: All patients with pleural infection at St Thomas’ Hospital, London treated with intrapleural fibrinolysis were included. Retrospective data was collected from Jan 2017 to Jan 2018. The starting dose was alteplase 2.5mg and DNase 5mg. Dose escalation was directed by the consultant. Results: 21 patients (ages 24-91) were included, of which 15 (71%) were treated successfully with 2.5mg alteplase. 2 required escalation to 5mg alteplase. 19 (90%) required 3 doses or less (table). 1 patient underwent medical thoracoscopy beforehand, and 1 needed surgery after. 8 (31%) required critical care admission due to sepsis; 3 for ECMO. 5 (24%) had metastatic cancer. There were no direct complications from fibrinolysis. 3 (14%) required blood transfusion for reasons unrelated to fibrinolysis. 3 patients died in hospital of reasons unrelated to pleural infection. Conclusions: Our data suggest that 2.5mg alteplase and 5mg DNase is safe and effective even in high risk patients. A larger prospective study will be needed to confirm this. 90% of patients received 3 doses or less. References: 1) Popowicz N et al. Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. Ann Am Thorac Soc. 2017 Jun;14(6):929-936. |
| Databáze: | OpenAIRE |
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