Mehta, Sanjay M, MD

Penetar, Katherine M, DNP, CRNP

Sterner, Lauren E

Wanamaker, Kelly M, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationUse of Thrombolytic Therapy for ComplicatedPleural EffusionsLauren E. SternerLauren.Sterner@lvhn.orgKelly M. Wanamaker MDLehigh Valley Health Network, Kelly.Wanamaker@lvhn.orgKatherine M. Penetar DNP, CRNPLehigh Valley Health Network, Katherine_M.Penetar@lvhn.orgSanjay M. Mehta MDLehigh Valley Health Network, Sanjay_M.Mehta@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtSterner, L. Wanamaker, K. Penetar, K. Mehta, S. (2019, August). Use of Thrombolytic Therapy for Complicated Pleural Effusions. PosterPresented at: LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• A complicated pleural effusion is defined as an accumulation of pleural fluid with fibrin deposits and a non-elastic pleural membrane peel.1• Treatment remains controversial; traditionally, surgical decortication has been the mainstay, however there are contraindications and an associated high morbidity.2• Intrapleural thrombolytic therapy offers an alternative to surgical intervention and alteplase has been shown to be an effective treatment.3Primary Objective: To determine the efficacy of intrapleural alteplase therapy in treatment of complex pleural effusion. Successful treatment is defined as resolutions or near resolutions in chest radiographs. Secondary Objective: To compare the length of hospital stay between traditional surgical treatment and that of intrapleural thrombolytic therapy. BACKGROUNDMETHODSOUTCOMES RESULTSCONCLUSIONSUse of Thrombolytic Therapy for Complicated Pleural Effusions Lauren Sterner, Kelly M. Wanamaker, MD, Katherine M. Penetar DNP, CRNP, Sanjay M. Mehta, MDDepartment of Cardiothoracic Surgery41%44%15%EmpyemaParapneumonicRetrospective chart review on adult admissions with a complicated pleural effusion treated with either thrombolytic therapy, pigtail tube, or surgical decortication from January 2016 to May 2019. The following information was collected: age, sex, etiology of pleural effusion, treatment, dosages of alteplase, success of treatments, complications and length of stay.  Descriptive statistics were used to evaluate the primary and secondary objectives and to summarize the details of each encounter.  Table 1. Comparison of Thrombolytic Therapy to Surgical Intervention.N (%)Md (IQR)Incidence of Full ResolutionAlteplase therapySurgical intervention27  (84.4%)32  (96.7%)ComplicationsAlteplase therapyBleedingSepsisRespiratory failureOther Surgical interventionBleedingSepsisRespiratory failureOther 0  (0%)2  (6.25%)2  (12.5%)4  (6.25)1  (3.03%)5  (15.2%)2  (3.03%)1  (3.03%)Length of stayAlteplase therapySurgical intervention6.5 (9.5)8 (9)• 98 patients total; 70 male, 28 female. • 32 (32.7%) were treated with thrombolytic therapy and resulted in full resolution in 84.4% of cases (27 out of 32 patients). • Five patients had an incomplete response to alteplase treatment, four of which required video-assisted thoracic surgery (VATS). The one patient was not a surgical candidate and received antibiotic therapy.Figure 1. Pleural effusion etiology for those with full resolution after thrombolytic therapy treatment.Figure 2. Average doses of alteplase based off the outcome of the thrombolytic therapy. • Overall, surgical intervention resulted in more cases  of complete resolution, but had a longer length of stay.• Those who had incomplete resolution of the effusion after thrombolytic therapy received less dosages of alteplase and dornase compared to those that did.• Alteplase therapy proves a good treatment option for most cases of complex fluid collection and in those in which surgery is contraindicated or those looking to avoid surgery. • Implementing a standard protocol of alteplase and dornase dosing combined with earlier intervention would optimize cases of complete resolution observed on imaging.Loculated1. Walker, C., Shirk, M., Tschampel, M., & Visconti, J. (2003). Intrapleural Altepase in a Patient with Complicated Pleural Effusion. The Annals of Pharamcology, 37, 376-379. doi:10.1345/aph.1C248 2. Piccolo, F., Popwicz, N., Wong, D., & Lee, Y. (2015). Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection. Journal of Thoracic Disease, 7(6), 999-1008. doi:10.3978/j.issn.2072-1439.2015.01.30 3. Ben-Or, S., Feins, R., Veeramachaneni, N., & Haithcock, B. (2011). Effectiveness and Risks Associated With Intrapleural Alteplase by Means of Tube Thoracostomy. The Society of Thoracic Surgeons, 4th ser., 860-864. doi:10.1016/j.athoracsur.2010.10.0823.67 ± 1.852.2 ± 0.8372.0 ± 0.817CompleteResolutionIncompleteResolutionSurgicalIntervention

Use of Thrombolytic Therapy for Complicated Pleural Effusions

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Use of Thrombolytic Therapy for Complicated Pleural Effusions

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