Open AccessSuccessful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime
Author(s) -
Hart Jodi Andrea,
Badiei Arash,
Lee Y C Gary
Publication year - 2019
Publication title -
respirology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.304
H-Index - 9
ISSN - 2051-3380
DOI - 10.1002/rcr2.408
Subject(s) - medicine , deoxyribonuclease , tissue plasminogen activator , parapneumonic effusion , coagulopathy , surgery , fibrinolysis , activator (genetics) , pleural effusion , plasminogen activator , anesthesia , pleural fluid , enzyme , receptor , biochemistry , chemistry
Pleural infection managed with intrapleural therapy using a combination of 10 mg of tissue plasminogen activator (tPA) and 5 mg of deoxyribonuclease (DNase) has been shown in randomized and open‐label studies to successfully treat >90% of patients without resorting to surgery. Potential bleeding risks, although low, and costs associated with tPA remain important concerns. No phase I studies exist for intrapleural tPA therapy and the lowest effective dose has not been established. In patients with high bleeding risks, lower doses may present a safer alternative. We report a case of a complex parapneumonic effusion in a patient with coagulopathy that was successfully treated with a very low dose tPA (1 mg) and DNase (5 mg) regime.