What is the role of intrapleural fibrinolysis in the treatment hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Intrapleural instillation of fibrinolytic agents is advocated in some centers for evacuation of residual hemothorax in cases in which initial tube thoracostomy drainage is inadequate. The proposed dose is 250,000 IU of streptokinase or 100,000 IU of urokinase in 100 mL of sterile saline. [43] Some centers prefer the use of tissue plasminogen activator (TPA). [44]

In a study of intrapleural fibrinolytic treatment of traumatic clotted hemothorax, daily instillations of fibrinolytic agents into the intrapleural the space for 2-15 days resulted in an overall success rate of 92%. [43] Nevertheless, the use of intrapleural instillation of fibrinolytic agents for the evacuation of hemothorax is not likely to become routine, because of the length of in-hospital time required for complete treatment and the risk of untoward effects.

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