A recent controlled trial has shown that intra-pleural streptokinase improves the tube drainage of infected pleural fluid (AJRCCM 1996:153(4): A462). Studies of crude indices of coagulation suggest this benefit is accompanied by little systemic fibrinolysis. To improve the estimation of the risks of intra-pleural streptokinase in humans, thi study examines its systemic fibrinolytic activity in detail. Eight patients (5M 3F, age 38, range 19-76) receiving 250,000 i.u. intra-pleural streptokinase to aid drainage of a loculated or infected pleural effusion were studied. In all subjects pleural drainage was via 14 French catheter flushed four times daily to maintain catheter patency and otherwise kept on -20 cmH2O suction. Streptokinase was introduced dissolved in 30 mls 0.9% saline and retained in the pleural cavity for two hours. Blood was taken before streptokinase administration for fibrinogen (FIB) and D-dimers due to fibrin degradation (DD), prothrombin (INR), activated partial thromboplastin (APTT) and thrombin (TT) ratios. These end points were remeasured at 5 and 24 hours after the administration of streptokinase. There were no changes of either statistical or physiological significance in any end point at 5 or 24 hours post-streptokinase (paired t-test). The baseline and averaged results (5 and 24 hour samples averaged together) are presented in the table. Baseline (SD) Mean (SD) after SK diff. (SD) paired t-test significance INR 1.24(0.11) 1.22(0.21) -0.02(0.25) p >0.8 APTT 1.01(018) 0.99(0.10) -0.02(0.13) p >0.6 TT 1.00(0.07) 0.88(0.31) -0.12(0.30) p >0.3 FIB gl-1 3.57(0.77) 3.86(0.68) 0.31(0.61) p >0.15 DD mcg ml-1 <0.6(0) <0.6(0) 0.00(0.00) p >0.9 250,000 i.u. of intra-pleural streptokinase produces no detectable systemic fibrinolysis in humans
