We reviewed the charts of all patients admitted to our hospital with complicated parapneumonic effusion or empyema from Januto July 1, 2019. However, we observed a higher rate of significant pleural bleeding as compared to the above studies. At our institution, we utilized a once daily concurrent administration technique and experienced good clinical efficacy. In a “real world” study, pleural bleeding requiring blood transfusion also occurred at a similar 1.8% rate. Intrapleural hemorrhage requiring blood transfusion was observed in 3.8% of the patients receiving combination therapy. The use of intrapleural alteplase (tPA) and dornase alfa (DNase) in the management of complicated parapneumonic effusions and empyema was demonstrated to improve chest tube drainage, reduce the requirement for thoracic surgical intervention, and reduce hospital length of stay as compared to placebo and alteplase use alone. Fibrinolytic therapy for intrapleural infections has been available since 1949, when it was initially described by Tillet and Sherry, as a therapy to facilitate improved drainage of infected pleural effusions. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Įmpyema and complicated parapneumonic effusions (CPE) are estimated to cost the United States healthcare system at least 500 million dollars a year and the former is associated with a mortality of at least 15%. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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