Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

BackgroundIn dealing with septated pleural effusion, intrapleural fibrinolytics may be a useful alternative for others such as use of video assisted thoracic surgery or the conventional thoracotomy. The use of intrapleural fibrinolytics may be a safer, easier and cost effective management option that can promote pleural fluid drainage.ObjectiveTo evaluate the role of intrapleural streptokinase as a fibrinolytic agent in the management of pleural effusion with adhesions.Patients and methodsThis study was designed as a case series study in a prospective manner. Twenty-five patients were included in the study. All were admitted at Chest Department, Assiut University Hospital .The study was conducted during the period between September 2013 and September 2014. All patients had septated pleural effusion; candidate for drainage with failure of satisfactory pleural fluid drainage 24 h following intercostal tube (ICT) placement provided that the tube was properly positioned and not obstructed. Streptokinase was given daily at a dose of 250,000 IU dissolved in 40 ml of normal saline instilled in the pleural cavity through the chest tube. Instillation was repeated as long as no serious complication occurred and the drained fluid volume was >100 cc with a maximum of 14 doses. Patients were assessed by the amount of drainage through intercostal drain, chest X-ray and chest ultrasound. Also patients were assessed carefully for evidence of complications.ResultsThe study revealed increased drainage of pleural fluid through intercostal tube after streptokinase instillation. The observation difference in fluid volume before and after streptokinase instillation is found to be highly significant statistically (p < 0.001) .Outcome was defined according to scoring of changes in X-ray and ultrasound with success rate of 60%. Chance of success increases when the adhesions are fine based on the sonographic features. No major adverse effects were noted.ConclusionWe conclude that intrapleural streptokinase therapy may be considered in septated pleural effusion as a safe and effective treatment; it may obviate the need for surgery.Also, the ultrasound echo features of adhesions could be considered as a predictor for the response.