Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study
Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study
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DOI：
10.1007/s00408-015-9807-6
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发表时间：
2015-12-01
期刊：
影响因子：
5
通讯作者：
Fernandez de Sevilla, Tomas
中科院分区：
文献类型：
--
作者：
Aleman, Carmen;Porcel, Jose M.;Fernandez de Sevilla, Tomas
背景：据报道，胸膜纤溶在成人复杂肺旁积液（CPPE）和肺气肿的治疗中具有潜在的益处。方法前瞻性、对照、随机、双盲研究，对CPPE或脓胸患者每24小时使用10 mg阿替普酶（最初考虑使用20 mg，但出血事件迫使剂量减少）和10万UI尿激酶进行评估，最多持续6天。主要目的是评估每种纤溶药物在第3天和第6天的成功率。治疗的成功被定义为临床和放射学的改善，使额外的纤溶剂剂量不必要，并最终导致解决。次要结局包括胸膜内纤溶剂的安全性、手术转诊、住院时间和死亡率。结果共纳入99例患者，其中51例接受阿替普酶治疗，48例接受尿激酶治疗。尿激酶和阿替普酶在第3天和第6天的成功率没有显著差异，但当仅考虑CPPE亚组时，尿激酶的治愈率很高。死亡率和手术需求没有差异（总体为3%）。5名（28%）接受20mg阿替普酶治疗的患者和4名（12%）接受10mg阿替普酶治疗的患者出现严重出血事件。结论：对于非化脓性CPPE患者，尿激酶可能比阿替普酶更有效，且不良事件发生率更低。
Background Pleurofibrinolysis has been reported to be potentially beneficial in the management of complicated parapneumonic effusions (CPPE) and empyemas in the adult population.Methods Prospective, controlled, randomized, and double-blind study, to evaluate intrapleural alteplase 10 mg (initially 20 mg was considered but bleeding events forced dose reduction) versus 100,000 UI urokinase every 24 h for a maximum of 6 days in patients with CPPE or empyemas. The primary aim was to evaluate the success rate of each fibrinolytic agent at 3 and 6 days. Success of therapy was defined as the presence of both clinical and radiological improvement, making additional fibrinolytic doses unnecessary, and eventually leading to resolution. Secondary outcomes included the safety profile of intrapleural fibrinolytics, referral for surgery, length of hospital stay, and mortality.Results A total of 99 patients were included, of whom 51 received alteplase and 48 urokinase. Success rates for urokinase and alteplase at 3 and 6 days were not significantly different, but when only the subgroup of CPPE was considered, urokinase resulted in a high proportion of cures. There were no differences in mortality or surgical need (overall, 3 %). Five (28 %) patients receiving 20 mg of alteplase and 4 (12 %) receiving 10 mg presented serious bleeding events.Conclusions If intrapleural fibrinolytics are intended to be used, urokinase may be more effective than alteplase in patients with non-purulent CPPE and have a lower rate of adverse events.