TITLE:
Description of Prescribing Practices of Intrapleural Tissue Plasminogen Activator and Intrapleural DNase Administration at a Tertiary Academic Medical Center
AUTHORS:
Heather Torbic, Gaspar Hacobian, Nahal Beik
KEYWORDS:
Intrapleural, Tissue Plasminogen Activator, DNase, Pleural Effusion
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.5 No.9,
August
19,
2014
ABSTRACT:
Objectives: To
describe the prescribing practices, preparation and administration techniques
of intrapleural (IP) tissue plasminogen activator (t-PA) and IP DNase in
patients at a tertiary academic medical center. Methods: Adult patients
receiving IP t-PA and IP DNase between January 1-December 31, 2012 were
retrospectively evaluated. Patients were included if they received IP t-PA
and/or IP DNase for a pleural infection and were excluded if they received IP
t-PA or IP DNase for chest tube clearance. Results: A total of 197 doses of IP
t-PA and IP DNase received amongst 30 patients were included. The mean age of
the patients included was 62 years old with 50% of the patients being female. Of
the 30 patients included, 18 patients (60%) received both IP t-PA and IP DNase
and 12 patients (40%) received only IP t-PA. The median dose of IP t-PA
received was 4 mg (IQR 2-10) and the median dose of IP DNase received was 5 mg
(IQR 5-5). Systemic antibiotics were administered to 77% of patients prior to
IP t-PA or IP DNase administration. Improved pleural effusion drainage was
reported in 70% of patients. Increased pain in the chest cavity during
administration of IP t-PA or IP DNase was reported in 7% of patients.
Conclusion: The majority of patients at our institution received concomitant IP
t-PA and IP DNase after systemic therapy for treatment of pleural infections
had been attempted. Administration of IP t-PA and IP DNase demonstrated
improved drainage of pleural infections with minimal harm to patients.