Use of Intrapleural Thrombolytic Agents in the Management of Acute Empyema Thoracis

In this article, we will discuss the Use of Intrapleural Thrombolytic Agents in the Management of Acute Empyema Thoracis. So, let’s get started.

Intrapleural Thrombolytic Agents

These agents have a role to break the loculations in multiloculated empyema. Intrapleural instillation of a fibrinolytic agent, i.e. streptokinase (usual dose is 250,000 U in 100 ml saline) or urokinase (100,000 U diluted in 100 ml of saline) or tissue plasminogen activator mg through a chest tube is helpful if drainage stops because of loculations and opacities on chest X-ray persist. After each instillation, the chest tube is clamped for 2 hours to allow the thrombolytic agents to attack the fibrin membranes responsible for loculations. Thrombolytic agents can be daily instilled for up to 14 days. This is a costly treatment. The intrapleural injection of thrombolytic agents does not affect the systemic coagulation system as these do not diffuse through the pleura.

Contraindications of Thrombolytic Therapy

  • Presence of bronchopleural fistula
  • Recent trauma
  • Recent bronchial suturing
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