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TPA for Pleural Effusion

A colleague contact me on August 24 about a relative who is an inpatient and is experiencing a pleural effusion subsequent to a MRSA infection. The MRSA has been treated and is resolved, but the effusion is mucinous and drains slowly. The surgeon was planning to use recombinant tissue plasminogen activator (TPA, Alteplase) to liquify the fluid. This was new to me, but is apparently a technique that is used from time to time, as indicated by the attached Cochrane Database metaanlysis (see link at end) describing the use of streptokinase and urokinase.

Approximately 350 mL of fluid had drained before the first infusion of TPA through the patient’s chest tube, which resulted in the further draining of 1000 mL. Over the weekend the physicians administered four more injections and over 2000 mL of effusion have been drained.

My colleague and I would like to learn from participants if you are familiar with this procedure, how safe is it, and how long does the TPA last in pleural fluid? We are hoping for a positive outcome.

Cochrane Database Abstract: Effusion Fibrinolysis

Here is a September 6 follow-up from my colleague: They discharged my brother on Friday, August 31 after five successful treatments of TPA. His lung capacity is now just about normal.

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