CHEST Guidelines-The-Use-of-Intrapleural-Thrombolytic-or-Fibrinolyt

The-Use-of-Intrapleural-Thrombolytic-or-Fibrinolyt

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The study by Gilbert et al. focuses on the safety of intrapleural thrombolytic therapy, particularly the use of alteplase (a thrombolytic agent), dornase alfa, or both, in patients with indwelling tunneled pleural catheters (IPCs). These IPCs are used for managing recurrent pleural effusions, which can occasionally become obstructed. The study seeks to understand the safety profile of such therapies in patients who may also be undergoing anticoagulation treatment, as previous studies typically exclude these patients.<br /><br />The research involved a retrospective review of 94 patients who underwent IPC placement and received intrapleural therapy between January 2009 and February 2020. Among these, 30 patients were on anticoagulation therapy, and medications were administered 71 times in anticoagulated patients and 172 times in non-anticoagulated patients. The study identified 20 complications in 18 patients; these included five bleeding complications. Importantly, the use of anticoagulation did not significantly increase the risk of bleeding complications, showing a 5.3% bleeding episode rate with no significant difference between those on anticoagulants and those who were not.<br /><br />These findings suggest a low incidence of complications from intrapleural thrombolytic therapy, including in anticoagulated patients. Despite the low reported risk, the study emphasizes the need for informed patient discussions about potential risks. The study calls for additional research to pinpoint specific risk factors for complications, particularly bleeding, in patients utilizing these therapies.<br /><br />Overall, the study concludes that intrapleural alteplase therapy in patients with IPCs, even when combined with anticoagulation, presents a relatively low risk of complications, highlighting its potential safety in this complex patient population. This work provides valuable insights for clinicians managing pleural effusions with intrapleural medications, particularly in anticoagulated individuals.

Keywords

intrapleural thrombolytic therapy

alteplase

dornase alfa

indwelling tunneled pleural catheters

recurrent pleural effusions

anticoagulation treatment

bleeding complications

retrospective review

patient safety

clinician insights