CHEST
Original ResearchPulmonary ProceduresIntrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study
Section snippets
Demographics
One hundred sixty-five patients at SCGH, 105 at SMH, 220 at JHH, and an estimated 1,200 patients at the University of Calgary underwent IPC insertion for the management of recurrent pleural effusions during the study period. A total of 66 patients (52% women) with a mean age of 64.7 (14.2) years fulfilled the inclusion criteria. Most patients (n = 64) had an MPE: 13 (20.3%) from malignant pleural mesothelioma, 20 (31%) from lung carcinoma, and the remainder from pleural metastases of
Discussion
Symptomatic pleural loculation is increasingly recognized as a relatively frequent complication of IPC use.3, 5 Fibrinolytic agents have been used in many centers to break down pleural loculations in the hope of reestablishing IPC fluid drainage, without the support of quality evidence or clear guidelines. To our knowledge, this multicenter observational study from four established IPC centers is the first to describe the clinical outcome of intrapleural fibrinolytics for IPC-related
Conclusions
Intrapleural fibrinolytic therapy can improve pleural drainage and symptoms in selected patients with IPC and symptomatic loculation but it carries a small risk of pleural bleeding. There is significant heterogeneity in how intrapleural fibrinolytics are currently used for IPC-related symptomatic loculation. This therapeutic option needs to be explored further to aid patient selection, determine the optimal dosing regimen, and define its safety profile.
Acknowledgments
Author contributions: Y. C. G. L. is the guarantor of this manuscript. R. T. and Y. C. G. L. contributed to the conception and design of the study; R. T., F. P., and T. H. contributed to the imaging analyses; R. T., F. P., and Y. C. G. L. contributed to the statistical analyses; and R. T., F. P., D. M., P. R. M., A. C. C., T. H., L. Y., R. B., H. J. L., D. F.-K., N. A. M., A. T., and Y. C. G. L. contributed to the pleural data collection and manuscript drafting, revision, and final approval.
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FUNDING/SUPPORT: Dr Thomas has received research scholarship support from NH&MRC, the Western Australia Cancer and Palliative Care Network (WACPCN), and LIWA, Australia. Dr Maskell has received research grant support from the National Institutes of Health Research (NIHR). Dr Y. C. G. Lee has received research grant support from the Sir Charles Gairdner Research Foundation, the Cancer Council of Western Australia, the Lung Institute of Western Australia (LIWA), Westcare, and the Dust Disease Board of New South Wales, Australia. Dr Y. C. G. Lee is a recipient of a National Health and Medical Research Council (NH&MRC) Career Development Fellowship.
originally published Online First March 5, 2015.
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