Bleeding Risk With Combination Intrapleural Fibrinolytic and Enzyme Therapy in Pleural Infection An International, Multicenter, Retrospective Cohort Study

被引：31

作者：

Akulian, Jason ^{[1
,2
]}

Bedawi, Eihab O. ^{[28
]}

Abbas, Hawazin ^{[4
]}

Argento, Christine ^{[5
]}

Arnold, David T.

Balwan, Akshu ^{[1
]}

Batra, Hitesh ^{[8
]}

Becerra, Juan Pablo Uribe ^{[9
]}

Belanger, Adam ^{[1
,2
,7
]}

Berger, Kristin ^{[10
]}

Burks, Allen Cole

Chang, Jiwoon ^{[11
]}

Chrissian, Ara A. ^{[12
]}

DiBardino, David M. ^{[15
]}

Fuentes, Xavier Fonseca ^{[17
]}

Gesthalter, Yaron B. ^{[13
]}

Gilbert, Christopher R. ^{[18
,19
]}

Glisinski, Kristen ^{[20
]}

Godfrey, Mark ^{[21
]}

Gorden, Jed A. ^{[18
,19
]}

Grosu, Horiana ^{[22
]}

Gupta, Mridul ^{[23
]}

Kheir, Fayez ^{[9
]}

Ma, Kevin C. ^{[15
]}

Majid, Adnan ^{[9
]}

Maldonado, Fabien ^{[24
]}

Maskell, Nick A.

Mehta, Hiren ^{[4
]}

Mercer, Joshua ^{[5
,17
]}

Mullon, John

Nelson, Darlene ^{[17
]}

Nguyen, Elaine ^{[12
]}

Pickering, Edward M. ^{[6
]}

Puchalski, Jonathan ^{[21
]}

Reddy, Chakravarthy ^{[25
]}

Revelo, Alberto E. ^{[26
]}

Roller, Lance ^{[24
]}

Sachdeva, Ashutosh ^{[6
]}

Sanchez, Trinidad ^{[27
]}

Sathyanarayan, Priya ^{[5
]}

Semaan, Roy ^{[16
]}

Senitko, Michal ^{[23
]}

Shojaee, Samira ^{[27
]}

Story, Ryan ^{[26
]}

Thiboutot, Jeffrey ^{[5
]}

Wahidi, Momen ^{[3
]}

Wilshire, Candice L. ^{[18
,19
]}

Yu, Diana ^{[14
]}

Zouk, Aline ^{[8
]}

Rahman, Najib M. ^{[28
]}

机构：

[1] Univ North Carolina Chapel Hill, Div Pulm & Crit Care, Sch Med, Chapel Hill, NC USA

[2] Univ North Carolina Chapel Hill, Carolina Ctr Pleural Dis, Sch Med, Chapel Hill, NC USA

[3] Duke Univ, Div Pulm & Crit Care, Durham, NC USA

[4] Univ Florida, Div Pulm Crit Care & Sleep Med, Gainesville, FL USA

[5] Johns Hopkins Univ Sch Med, Div Pulm & Crit Care, Sch Med, Baltimore, MD USA

[6] Univ Maryland, Div Pulm & Crit Care, Sch Med, Baltimore, MD USA

[7] Univ New Mexico, Div Pulm Crit Care & Sleep Med, Sch Med, Albuquerque, NM USA

[8] Univ Alabama Birmingham, Div Pulm Allergy & Crit Care Med, Birmingham, AL USA

[9] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Thorac Surg & Intervent Pulmonol, Boston, MA USA

[10] Weill Cornell Med, Div Pulm & Crit Care Med, New York, NY USA

[11] Stanford Univ, Div Pulm Allergy & Crit Care Med, Sch Med, Palo Alto, CA USA

[12] Loma Linda Univ, Div Pulm Crit Care Hyperbar Allergy & Sleep Med, Loma Linda, CA USA

[13] Univ Calif San Francisco, Div Pulm Crit Care Allergy & Sleep, San Francisco, CA USA

[14] Univ Southern Calif, Keck Sch Med, Div Pulm Crit Care & Sleep Med, Los Angeles, CA USA

[15] Univ Penn, Perelman Sch Med, Div Pulm Allergy & Crit Care Med, Sect Intervent Pulmonol, Philadelphia, PA USA

[16] Univ Pittsburgh, Div Pulm Allergy & Crit Care Med, Sch Med, Pittsburgh, PA USA

[17] Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA

[18] Swedish Canc Inst, Div Thorac Surg & Intervent Pulmonol, Seattle, WA USA

[19] Ctr Lung Canc Res Honor Wayne Gittinger, Seattle, WA USA

[20] Natl Jewish Hlth, Div Pulm & Crit Care, Denver, CO USA

[21] Yale Univ, Div Pulm & Crit Care, Sch Med, New Haven, CT USA

[22] Univ Texas MD Anderson Canc Ctr, Div Pulm & Crit Care, Houston, TX USA

[23] Univ Mississippi, Div Pulm Crit Care & Sleep Med, Med Ctr, Jackson, MS USA

[24] Vanderbilt Univ, Div Allergy Pulm & Crit Care Med, Med Ctr, Nashville, TN USA

[25] Univ Utah, Div Pulm & Crit Care, Salt Lake City, UT USA

[26] Ohio State Univ, Div Pulm Crit Care & Sleep Med, Intervent Pulmonol Sect, Wexner Med Ctr, Columbus, OH USA

[27] Virginia Commonwealth Univ, Div Pulm & Crit Care, Richmond, VA USA

[28] Oxford Univ Hosp NHS Fdn Trust, Oxford Pleural Unit, Oxford, England

来源：

CHEST | 2022年 / 162卷 / 06期

关键词：

bleeding; empyema; fibrinolysis; intrapleural; parapneumonic pleural effusion; TISSUE-PLASMINOGEN ACTIVATOR; CONTROLLED-TRIAL; ALTEPLASE; EPIDEMIOLOGY; MANAGEMENT; DNASE;

D O I：

10.1016/j.chest.2022.06.008

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, studies specifically designed and adequately powered to address complications are sparse. The safety profile, the effects of concurrent therapeutic anticoagulation, and the nature and extent of nonbleeding complications remain poorly defined. RESEARCH QUESTION: What is the bleeding complication risk associated with IET use in pleural infection? STUDY DESIGN AND METHODS: This was a multicenter, retrospective observational study conducted in 24 centers across the United States and the United Kingdom. Protocolized data collection for 1,851 patients treated with at least one dose of combination IET for pleural infection between January 2012 and May 2019 was undertaken. The primary outcome was the overall incidence of pleural bleeding defined using pre hoc criteria. RESULTS: Overall, pleural bleeding occurred in 76 of 1,833 patients (4.1%; 95% CI, 3.0%-5.0%). Using a half-dose regimen (tissue plasminogen activator, 5 mg) did not change this risk significantly (6/172 [3.5%]; P = .68). Therapeutic anticoagulation alongside IET was associated with increased bleeding rates (19/197 [9.6%]) compared with temporarily withholding anticoagulation before administration of IET (3/118 [2.6%]; P = .017). As well as systemic anticoagulation, increasing RAPID score, elevated serum urea, and platelets of < 100 x 109/L were associated with a significant increase in bleeding risk. However, only RAPID score and use of systemic anticoagulation were independently predictive. Apart from pain, non-bleeding complications were rare. INTERPRETATION: IET use in pleural infection confers a low overall bleeding risk. Increased rates of pleural bleeding are associated with concurrent use of anticoagulation but can be mitigated by withholding anticoagulation before IET. Concomitant administration of IET and therapeutic anticoagulation should be avoided. Parameters related to higher IET-related bleeding have been identified that may lead to altered risk thresholds for treatment.

引用

页码：1384 / 1392

页数：9

共 25 条

[1] Intrapleural fibrinolytic therapy (IPFT) in loculated pleural effusions-analysis of predictors for failure of therapy and bleeding: a cohort study [J].

Abu-Daff, Saleh ;

Maziak, Donna E. ;

Alshehab, Derar ;

Threader, Jennifer ;

Ivanovic, Jelena ;

Deslaurier, Valerie ;

Villeneuve, Patrick-James ;

Gilbert, Sebastian ;

Sundaresan, Sudhir ;

Shamji, Farid ;

Lougheed, Colleen ;

Seely, Jean M. ;

Seely, Andrew J. E. .

BMJ OPEN, 2013, 3 (02)

[2] Intrapleural Fibrinolysis with Urokinase Versus Alteplase in Complicated Parapneumonic Pleural Effusions and Empyemas: A Prospective Randomized Study [J].

Aleman, Carmen ;

Porcel, Jose M. ;

Alegre, Jose ;

Ruiz, Eva ;

Bielsa, Silvia ;

Andreu, Jordi ;

Deu, Maria ;

Sune, Pilar ;

Martinez-Sogues, Mireia ;

Lopez, Iker ;

Pallisa, Esther ;

Antoni Schoenenberger, Joan ;

Bruno Montoro, J. ;

Fernandez de Sevilla, Tomas .

LUNG, 2015, 193 (06) :993-1000

[3] Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema [J].

Altmann, Emile S. ;

Crossingham, Iain ;

Wilson, Stephen ;

Davies, Huw R. .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2019, (10)

[4] Epidemiology of pleural empyema in English hospitals and the impact of influenza [J].

Arnold, David T. ;

Hamilton, Fergus W. ;

Morris, Tim T. ;

Suri, Tim ;

Morley, Anna ;

Frost, Vicky ;

Vipond, Ian B. ;

Medford, Andrew R. ;

Payne, Rupert A. ;

Muir, Peter ;

Maskell, Nick A. .

EUROPEAN RESPIRATORY JOURNAL, 2021, 57 (06)

[5] Epidemiology and prognostic factors of pleural empyema [J].

Bobbio, Antonio ;

Bouam, Samir ;

Frenkiel, Jerome ;

Zarca, Kevin ;

Fournel, Ludovic ;

Canny, Emelyne ;

Icard, Philippe ;

Porcher, Raphael ;

Alifano, Marco .

THORAX, 2021, 76 (11) :1117-1123

[6] Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement [J].

Chaddha, Udit ;

Agrawal, Abhinav ;

Feller-Kopman, David ;

Kaul, Viren ;

Shojaee, Samira ;

Maldonado, Fabien ;

Ferguson, Mark K. ;

Blyth, Kevin G. ;

Grosu, Horiana B. ;

Corcoran, John P. ;

Sachdeva, Ashutosh ;

West, Alex ;

Bedawi, Eihab ;

Majid, Adnan ;

Mehta, Ravindra M. ;

Folch, Erik ;

Liberman, Moishe ;

Wahidi, Momen M. ;

Gangadharan, Sidhu P. ;

Roberts, Mark E. ;

DeCamp, Malcolm M. ;

Rahman, Najib M. .

LANCET RESPIRATORY MEDICINE, 2021, 9 (09) :1050-1064

[7] Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study [J].

Corcoran, John P. ;

Psallidas, Ioannis ;

Gerry, Stephen ;

Piccolo, Francesco ;

Koegelenberg, Coenraad F. ;

Saba, Tarek ;

Daneshvar, Cyrus ;

Fairbairn, Ian ;

Heinink, Richard ;

West, Alex ;

Stanton, Andrew E. ;

Holme, Jayne ;

Kastelik, Jack A. ;

Steer, Henry ;

Downer, Nicola J. ;

Haris, Mohammed ;

Baker, Emma H. ;

Everett, Caroline F. ;

Pepperell, Justin ;

Bewick, Thomas ;

Yarmus, Lonny ;

Maldonado, Fabien ;

Khan, Burhan ;

Hart-Thomas, Alan ;

Hands, Georgina ;

Warwick, Geoffrey ;

De Fonseka, Duneesha ;

Hassan, Maged ;

Munavvar, Mohammed ;

Guhan, Anur ;

Shahidi, Mitra ;

Pogson, Zara ;

Dowson, Lee ;

Popowicz, Natalia D. ;

Saba, Judith ;

Ward, Neil R. ;

Hallifax, Rob J. ;

Dobson, Melissa ;

Shaw, Rachel ;

Hedley, Emma L. ;

Sabia, Assunta ;

Robinson, Barbara ;

Collins, Gary S. ;

Davies, Helen E. ;

Yu, Ly-Mee ;

Miller, Robert F. ;

Maskell, Nick A. ;

Rahman, Najib M. .

EUROPEAN RESPIRATORY JOURNAL, 2020, 56 (05)

[8] Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem [J].

Daley, Mitchell J. ;

Murthy, Manasa S. ;

Peterson, Evan J. .

THERAPEUTIC ADVANCES IN DRUG SAFETY, 2015, 6 (02) :57-66

[9] Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010 [J].

Davies, Helen E. ;

Davies, Robert J. O. ;

Davies, Christopher W. H. .

THORAX, 2010, 65 :41-53

[10] Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: Effectiveness and risk for hemorrhage [J].

Gervais, Debra A. ;

Levis, Diane A. ;

Hahn, Peter F. ;

Uppot, Raul N. ;

Arellano, Ronald S. ;

Mueller, Peter R. .

RADIOLOGY, 2008, 246 (03) :956-963

← 1 2 3 →