Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Alawady, Tamer; Elsharawy, Mamdouh; Elfakharany, Karim; Samra, Saad Rabie; Abdelsalam, Ashraf Hamed

doi:10.21608/zumj.2022.128169.2528

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Document Type : Original Article

Authors

¹ Cardiothoracic Surgery Department, Faculty Medicine, Zagazig University, Zagazig, Egypt

² Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt

³ Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Egypt

⁴ Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

⁵ Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

10.21608/zumj.2022.128169.2528

Abstract

Abstract
Objective: Intrapleural fibrinolytics installation is considered an alternative method to aggressive operative intervention. This conservative medical management may decrease morbidity and mortality that were recorded with surgery. Our study investigates the outcome of tissue plasminogen activator (TPA), alteplase, and streptokinase (SK) as a treatment for stage II of empyema. Methods: This study prospectively evaluated 38 patients that had stage II of empyema. The patients were divided into two groups with installing one fibrinolytic protocol into chest tube for each group; group A, (TPA) and group B, (SK). The evaluation was based upon clinical examination and radiological findings for efficacy of each protocol. Results: There were no differences in baseline characteristics between both groups. There was a significant improvement after 1st, where 11 patients (52.4%) improved in TPA group with only 3 patients (17.6%) in SK group. TPA group showed 100% success on the other hand SK Group had 2 patients failure (11.8%) and surgical intervention was necessary for them. Hemorrhagic complications were 9.5% and 17.6% for TPA and SK respectively. Finally, there was a significant prolonged duration of mean hospital stay with SK therapy (5.48 vs 8.59 days). Conclusion: Both fibrinolytic protocols were effective and safe for empyema management, but Alteplase had better outcome.

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