Description of Prescribing Practices of Intrapleural Tissue Plasminogen Activator and Intrapleural DNase Administration at a Tertiary Academic Medical Center

DOI: 10.4236/pp.2014.59099   PDF   HTML     4,031 Downloads   4,662 Views  

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.

Share and Cite:

Torbic, H. , Hacobian, G. and Beik, N. (2014) Description of Prescribing Practices of Intrapleural Tissue Plasminogen Activator and Intrapleural DNase Administration at a Tertiary Academic Medical Center. Pharmacology & Pharmacy, 5, 890-894. doi: 10.4236/pp.2014.59099.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Light, R.W., Girard, W.M., Jenkinson, S.G. and George, R.B. (1980) Parapneumonic Effusions. American Journal of Medicine, 69, 507-512.
http://dx.doi.org/10.1016/0002-9343(80)90460-X
[2] Farjah, F., Symons, R.G., Krishnadasan, B., Wood, D.E. and Flum, D.R. (2007) Management of Pleural Space Infections: A Population-Based Analysis. Journal of Thoracic and Cardiovascular Surgery, 133, 346-351.
http://dx.doi.org/10.1016/j.jtcvs.2006.09.038
[3] Maslove, D.M., Chen, B.T., Wang, H. and Kuschner, W.G. (2013) The Diagnosis and Management of Pleural Effusions in the ICU. Journal of Intensive Care Medicine, 1, 24-26.
http://dx.doi.org/10.1177/0885066611403264
[4] Maskell, N.A., Davies, C.W.H., Nunn, A.J., et al. (2005) U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection. New England Journal of Medicine, 352, 865-874.
http://dx.doi.org/10.1056/NEJMoa042473
[5] Netten, A., Dennett, J. and Knight, J. (1999) Unit Costs of Health and Social Care. Personal Social Services Research Unit, University of Kent. Canterbury.
[6] Davies, R.J., Traill, Z.C. and Gleeson, F.V. (1997) Randomised Controlled Trial of Intrapleural Streptokinase in Community Acquired Pleural Infection. Thorax, 52, 416-421.
http://dx.doi.org/10.1136/thx.52.5.416
[7] Bouros, D., Schiza, S., Tzanakis, N., Chalkiadakis, G., Drositis, J. and Siafakas, N. (1999) Intrapleural Urokinase versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema: A Randomized, Double-Blind Study. American Journal of Respiratory and Critical Care Medicine, 159, 37-42.
http://dx.doi.org/10.1164/ajrccm.159.1.9803094
[8] Tokuda, Y., Matsushima, D., Stein, G.H. and Miyagi, S. (2006) Intrapleural Fibrinolytic Agents for Empyema and Complicated Parapneumonic Effusions: A Meta Analysis. Chest, 129, 783-790.
http://dx.doi.org/10.1378/chest.129.3.783
[9] Rahman, N.M., Phil, D., Maskell, N.A., et al. (2011) Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection. New England Journal of Medicine, 365, 518-526.
http://dx.doi.org/10.1056/NEJMoa1012740
[10] Skeete, D.A., Rutherford, E.J., Schlidt, S.A., Abrams, J.E., Parker, L.A. and Rich, P.B. (2004) Intrapleural Tissue Plasminogen Activator for Complicated Pleural Effusions. Journal of Trauma, 57, 1178-1183.
http://dx.doi.org/10.1097/01.TA.0000141879.67441.52
[11] Diacon, A.H., Theron, J., Schuurmans, M.M., Van de Wal, B.W. and Bolliger, C.T. (2004) Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions. American Journal of Respiratory and Critical Care Medicine, 170, 49-53.
http://dx.doi.org/10.1164/rccm.200312-1740OC
[12] Tuncozgur, B., Ustunsoy, H., Sivrikoz, M.C., et al. (2001) Intrapleural Urokinase in the Management of Parapneumonic Empyema: A Randomised Controlled Trial. International Journal of Clinical Practice, 55, 658-660.
[13] Simpson, G., Roomes, D. and Reeves, B. (2003) Successful Treatment of Empyema Thoracis with Human Recombinant Deoxyribonuclease. Thorax, 58, 365-366.
http://dx.doi.org/10.1136/thorax.58.4.365

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.