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Abu-Daff S, Maziak DE, Alshehab D, et al. Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study. BMJ Open. 2013;3(2)doi: 10.1136/bmjopen-2012-001887.
Abu-Daff, S., Maziak, D. E., Alshehab, D., Threader, J., Ivanovic, J., Deslaurier, V., Villeneuve, P. J., Gilbert, S., Sundaresan, S., Shamji, F., Lougheed, C., Seely, J. M., & Seely, A. J. (2013). Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study. BMJ open, 3(2), . https://doi.org/10.1136/bmjopen-2012-001887
Abu-Daff, Saleh, et al. "Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study." BMJ open vol. 3,2 (2013). doi: https://doi.org/10.1136/bmjopen-2012-001887
Abu-Daff S, Maziak DE, Alshehab D, Threader J, Ivanovic J, Deslaurier V, Villeneuve PJ, Gilbert S, Sundaresan S, Shamji F, Lougheed C, Seely JM, Seely AJ. Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study. BMJ Open. 2013 Jan 31;3(2). doi: 10.1136/bmjopen-2012-001887. Print 2013. PMID: 23377992; PMCID: PMC3586180.
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BMJ Open. 2013 Jan 31;3(2). doi: 10.1136/bmjopen-2012-001887. Print 2013.

Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions--analysis of predictors for failure of therapy and bleeding: a cohort study.

BMJ open

Saleh Abu-Daff, Donna E Maziak, Derar Alshehab, Jennifer Threader, Jelena Ivanovic, Valerie Deslaurier, Patrick-James Villeneuve, Sebastian Gilbert, Sudhir Sundaresan, Farid Shamji, Colleen Lougheed, Jean M Seely, Andrew J E Seely

Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, University of Ottawa and the Ottawa Hospital, Ottawa, Canada.

PMID: 23377992 PMCID: PMC3586180 DOI: 10.1136/bmjopen-2012-001887

Abstract

OBJECTIVES: To assess risk factors associated with failure and bleeding in intrapleural fibrinolytic therapy (IPFT) for pleural effusions.

DESIGN: Retrospective case series.

SETTING: Two tertiary-care centres in North America.

PARTICIPANTS: We identified 237 cases that received IPFT for the treatment of pleural effusions. Data for 227 patients were compiled including demographics, investigations, radiological findings pretherapy and post-therapy and outcomes.

INTERVENTION: Fibrinolytic therapy in the form of tissue plasminogen activator (t-PA) or streptokinase.

PRIMARY AND SECONDARY OUTCOMES: Success of therapy is defined as the presence of both clinical and radiological improvement leading to resolution. Failure was defined as persistence (ie, ineffective treatment) or complications requiring intervention from IPFT. Incidence of bleeding post-IPFT, identifying factors related to failure of therapy and bleeding.

RESULTS: IPFT was used in 237 patients with pleural effusions; 163 with empyema/complicated parapneumonic effusions, 32 malignant effusions and 23 with haemothorax. Overall, resolution was achieved in 80% of our cases. Failure occurred in 46 (20%) cases. Multivariate analysis revealed that failure was associated with the presence of pleural thickening (>2 mm) on CT scan (p=0.0031, OR 3, 95% CI 1.46 to 6.57). Bleeding was not associated with any specific variable in our study (antiplatelet medications, p=0.08).

CONCLUSIONS: Pleural thickening on a CT scan was found to be associated with failure of IPFT.

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