Patients with malignant mesothelioma may present with hemothorax. We used a combination of oral and intrapleural tranexamic acid to treat two patients with this severe complication. Initiation of treatment with this potent anti-fibrinolytic drug resulted in rapid reduction of bleeding and of transfusion requirements.

BACKGROUND More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is the key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial therapy (Multicenter Intrapleural Sepsis Trial [MIST1]). METHODS Objective: To evaluate the efficacy and safety of intrapleural DNase alone...

BACKGROUND Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous draina...

Intrapleural fibrinolysis has been investigated for the treatment of pleural effusion for several decades. Fibrinolytics have the ability to break up fibrin and loculations that characterize complicated pleural effusions, facilitating drainage. Older fibrinolytics such as urokinase and streptokinase have been replaced by tissue plasminogen activator (tPA) for this indication due to product avai...

Intrapleural fibrinolytics probably improve the drainage of loculated pleural effusions and empyemas. Studies of crude indices of systemic coagulation suggest this effect is accompanied by little systemic fibrinolysis, but few studies have assessed this in detail. This study examines the systemic fibrinolytic activity of two intrapleural streptokinase (IPSK) regimes in detail. Eight patients re...

The use of intrapleural therapy with tissue plasminogen activator and DNase improves outcomes in patients with complicated pleural space infections. However, little data exists for the use of combination intrapleural therapy after the initial dosing period of six doses. We sought to describe the safety profile and outcomes of intrapleural therapy beyond this standard dosing. A retrospective rev...

Thrombolytic therapy, which involves the administration of agents designed to increase fibrinolytic capacity, has been utilized in respiratory medicine for more than 50 years. A variety of agents have been used to effect thrombolysis, including urokinase plasminogen activator (uPA) and streptokinase. Tissue plasminogen activator (tPA) has also been used to effect thrombolysis. Both uPA and tPA ...

BACKGROUND Pleural fluid loculations due to complicated parapneumonic effusion (CPE), empyema, tubercular effusion and traumatic hemothorax can be managed either by video-assisted thoracoscopic surgery (VATS) or intrapleural ibrinolytic therapy (IPFT). The former is more invasive, not easily available and is also more expensive. On the other hand, IPFT is less invasive, cheaper, easily accessi...