Tissue Plasminogen Activator with Prolonged Dwell Time Effectively Evacuates Pleural Effusions

Abstract

Abstract Objectives Fibrinolytic therapy can be effective for management of complex pleural effusions. Tissue plasminogen activator (tPA, 10 mg) and deoxyribonuclease (DNAse) every 12 hours with a dwell time of one hour is a common strategy based on published data. We used a simpler protocol of tPA (4 mg) without DNAse but with a longer dwell time of 12 hours, repeated daily. We reviewed our results. Methods Charts were reviewed and demographics, clinical data and treatment information were abstracted. Outcomes were assessed based on radiographic findings and need for surgery. Results 215 effusions in 207 patients (8 bilateral) were identified. 85% were either infectious or malignant. 249 chest tubes were used: 84% were 10 Fr or 12 Fr and 7% were PleurX®. 531 doses of tPA were given. The median number of doses per effusion was 2 (range 1–10), and 84% of effusions were treated with three or fewer doses. There were no significant bleeding complications. Median time to chest tube removal was 6 days (range 1 to 98, IQR 4 to 10). Drainage was considered complete for 78% of effusions, while 6% required decortication. Conclusions Low dose tPA daily with a 12 hour dwell time may be as effective as the standard regimen of tPA and DNAse twice daily with one hour dwell. For the most patients only three doses were required, and small pigtail catheters were sufficient. This regimen uses less medication and is logistically much easier than the current standard.