The use of intrapleural thrombolytic and/or fibrinolytic therapy via indwelling tunneled pleural catheters with or without concurrent anticoagulation usage.

Document Type

Article

Publication Date

3-18-2021

Publication Title

Chest

Keywords

washington; seattle; swedish cancer

Abstract

BACKGROUND: Indwelling tunneled pleural catheters are commonly used for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (i.e., alteplase) to restore flow. The safety profile of intrapleural medications has been previously published, however most studies exclude anticoagulated patients.

RESEARCH QUESTION: What is the safety profile of intrapleural alteplase and/or dornase alfa when utilized in indwelling tunneled pleural catheters, including patients that may be undergoing active anticoagulation?

STUDY DESIGN AND METHODS: Retrospective review of previously placed indwelling tunneled pleural catheters from January 2009 - February 2020 undergoing intrapleural alteplase. Basic demographics, laboratory studies, anticoagulation medication usage, and complications were collected. Descriptive statistics were used to report demographics and outcomes. Univariate Firth's logistic regression analyses were used to identify factors associated with complications, followed by multivariable regression analyses.

RESULTS: A total of 94 patients underwent indwelling tunneled pleural catheter placement and intrapleural instillation. The median age of patients was 66.1 (IQR - 57.6-74.9) years. Intrapleural medications were administered 71 times in 30 anticoagulated patients and 172 times in 64 not anticoagulated patients. A total of 20 complications were identified in 18 patients, and one experiencing more than one complication. There were 5 bleeding complications with no significant increased risk with anticoagulation usage (2 anticoagulated, 3 not anticoagulated; p=0.092). Multivariable Firth's logistic regression demonstrated that alteplase dose (p=0.04) and anticoagulation usage (p=0.05) were associated with any complication, but not associated with bleeding complications.

INTERPRETATION: We report a relatively low incidence of complications and in particular, bleeding complications in patients receiving intrapleural alteplase for non-draining IPCs. Bleeding episodes occurred in 5/94 (5.3%) patients with no apparent increased risk of bleeding complication, whether receiving anticoagulation or not. Additional study is warranted to identify risk factors for complications, in particular bleeding complications in this patient population.

Clinical Institute

Cancer

Department

Surgery

Department

Pulmonary Medicine

Department

Swedish Thoracic Surgery

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