Open AccessTissue plasminogen activator and pulmozyme for postoperative-retained hemothorax: A safe alternative to postoperative re-exploration
Author(s) -
Melissa E Pastoressa,
Truong Ma,
Nicholas Panno,
Michael S. Firstenberg
Publication year - 2017
Publication title -
international journal of critical illness and injury science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.274
H-Index - 12
eISSN - 2231-5004
pISSN - 2229-5151
DOI - 10.4103/2229-5151.207741
Subject(s) - medicine , thoracostomy , hemothorax , surgery , thoracotomy , fibrinolytic therapy , tissue plasminogen activator , empyema , plasminogen activator , fibrinolysis , fibrinolytic agent , pneumothorax
Successful treatment of traumatic hemothoraces is imperative to reduce morbidity and mortality among patients. Treatment modalities range from more conservative to invasive measures, including antibiotic therapy, thoracostomy tube placement, video-assisted thoracoscopic surgery, or thoracotomy. Various studies have documented success in using fibrinolytics such as tissue plasminogen activator (tPA) in conjunction with deoxyribonuclease administered through a chest tube to resolve a hemothorax. The optimal dose and frequency of fibrinolytic therapy have not yet been determined although most studies report administering therapy two times a day for 3 days. We report a successful case of a one-time dose of fibrinolytic therapy through thoracostomy tube which could support that a single dose may be ideal and sufficient enough to resolve a hemothorax. We also performed this in the acute postoperative period, which has not been well studied, and believe fibrinolytic therapy can be safe to use in this setting.