Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax.

Abstract

BACKGROUND:

When retained hemothorax occurs, video-assisted thoracoscopy or thoracotomy is performed, but recently, tissue plasminogen activator (tPA) has been used. This study evaluated intrapleural tPA use for retained traumatic hemothoraces.

METHODS:

A retrospective review was conducted of trauma patients treated with intrapleural tPA for retained hemothorax. Data included demographics, past medical and surgical histories, injury details, treatment details, and outcomes.

RESULTS:

Seven patients (median age = 47 years, male = 6, blunt trauma = 6) met study criteria. All patients received a chest tube. Six patients later received computed tomography-guided drains for tPA infusion. Number of tPA treatments per patient varied from 1 to 5. Median total tPA dosage was 24 mg. Median time from injury to chest tube placement was 11 days and from chest tube placement to first tPA treatment was 4 days. No patients required a video-assisted thoracoscopy; however, 1 patient required thoracotomy. There were no deaths or bleeding complications attributed to intrapleural tPA.

CONCLUSION:

Although future studies are needed to identify optimum treatment guidelines, intrapleural tPA appears to be a safe and efficacious treatment option.

• Authors: P J Stiles, Rachel M Drake, Stephen D Helmer, Paul M Bjordahl, James M Haan
• Journal: American journal of surgery (Am J Surg) Vol. 207 Issue 6 Pg. 960-3 (Jun 2014) ISSN: 1879-1883 [Electronic] United States
• PMID: 24495319 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Adult
• Aged
• Aged, 80 and over
• Chest Tubes
• Comorbidity
• Female
• Fibrinolytic Agents (administration & dosage)
• Hemothorax (drug therapy, etiology)
• Humans
• Male
• Middle Aged
• Radiography, Interventional
• Retrospective Studies
• Risk Factors
• Thoracic Injuries (complications, surgery)
• Thoracic Surgery, Video-Assisted
• Thoracotomy
• Tissue Plasminogen Activator (administration & dosage)
• Tomography, X-Ray Computed
• Treatment Outcome