QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Walker, C. A Articles by Visconti, J. A Search for Related Content PubMed PubMed Citation Articles by Walker, C. A Articles by Visconti, J. A

Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

Clinical Pharmacy Specialist, Chalmers P Wylie Veterans Affairs Outpatient Clinic, Columbus, OH

Mary Beth Shirk, PharmD BScPharm

Specialty Practice Pharmacist, Critical Care, The Ohio State University Medical Center, Columbus, OH; Clinical Assistant Professor, College of Pharmacy, The Ohio State University

Marva M Tschampel, BScPharm

Drug Information Specialist, The Ohio State University Medical Center; Clinical Assistant Professor, College of Pharmacy, The Ohio State University

James A Visconti, PhD

Director, Drug Information, The Ohio State University Medical Center; Professor, Pharmacy Practice and Administration, College of Pharmacy, The Ohio State University

Reprints: Mary Beth Shirk PharmD, Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210-1228, FAX 614/293-3165, E-mail shirk-1{at}medctr.osu.edu

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE).

CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention.

DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE.

CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.

Key Words: alteplase, complicated pleural effusion, empyema, fibrinolytics, thrombolytics

Published Online, February 9, 2003. www.theannals.com, DOI 10.1345/aph.1C248

This article has been cited by other articles:

				J. E. Heffner, J. S. Klein, and C. Hampson Interventional Management of Pleural Infections Chest, October 1, 2009; 136(4): 1148 - 1159. [Abstract] [Full Text] [PDF]

				C. R. Emerson, C. M. Bercume, M. S. Antonopoulos, and N. Marzella The Administration of rt-PA (Activase(R)) for the Treatment of Empyema in an Adult Patient Journal of Pharmacy Practice, February 1, 2009; 22(1): 117 - 123. [Abstract] [PDF]