Intrapleural use of tissue plasminogen activator and DNase in pleural infection.

Rahman, N; Maskell, N; West, A; Teoh, R; Arnold, A; Mackinlay, C; Peckham, D; Davies, C; Ali, N; Kinnear, W; Bentley, A; Kahan, B; Wrightson, J; Davies, H; Hooper, C; Lee, Y; Hedley, E; Crosthwaite, N; Choo, L; Helm, E; Gleeson, F; Nunn, A; Davies, R

Journal article

Intrapleural use of tissue plasminogen activator and DNase in pleural infection.

Abstract:: BACKGROUND: More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial. METHODS: We conducted a blinded, 2-by-2 factorial trial in which 210 patients with pleural infection were randomly assigned to receive one of four study treatments for 3 days: double placebo, intrapleural tissue plasminogen activator (t-PA) and DNase, t-PA and placebo, or DNase and placebo. The primary outcome was the change in pleural opacity, measured as the percentage of the hemithorax occupied by effusion, on chest radiography on day 7 as compared with day 1. Secondary outcomes included referral for surgery, duration of hospital stay, and adverse events. RESULTS: The mean (±SD) change in pleural opacity was greater in the t-PA-DNase group than in the placebo group (-29.5±23.3% vs. -17.2±19.6%; difference, -7.9%; 95% confidence interval [CI], -13.4 to -2.4; P=0.005); the change observed with t-PA alone and with DNase alone (-17.2±24.3 and -14.7±16.4%, respectively) was not significantly different from that observed with placebo. The frequency of surgical referral at 3 months was lower in the t-PA-DNase group than in the placebo group (2 of 48 patients [4%] vs. 8 of 51 patients [16%]; odds ratio for surgical referral, 0.17; 95% CI, 0.03 to 0.87; P=0.03) but was greater in the DNase group (18 of 46 patients [39%]) than in the placebo group (odds ratio, 3.56; 95% CI, 1.30 to 9.75; P=0.01). Combined t-PA-DNase therapy was associated with a reduction in the hospital stay, as compared with placebo (difference, -6.7 days; 95% CI, -12.0 to -1.9; P=0.006); the hospital stay with either agent alone was not significantly different from that with placebo. The frequency of adverse events did not differ significantly among the groups. CONCLUSIONS: Intrapleural t-PA-DNase therapy improved fluid drainage in patients with pleural infection and reduced the frequency of surgical referral and the duration of the hospital stay. Treatment with DNase alone or t-PA alone was ineffective. (Funded by an unrestricted educational grant to the University of Oxford from Roche UK and by others; Current Controlled Trials number, ISRCTN57454527.).

Publication status:: Published

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Share
Cite

Cite this record

APA Style

Rahman, N., Maskell, N., West, A., Teoh, R., Arnold, A., Mackinlay, C., Peckham, D., Davies, C., Ali, N., Kinnear, W., Bentley, A., Kahan, B., Wrightson, J., Davies, H., Hooper, C., Lee, Y., Hedley, E., Crosthwaite, N., Choo, L., … Davies, R. (2011). Intrapleural use of tissue plasminogen activator and DNase in pleural infection. New England Journal of Medicine, 365(6), 518–526.

MLA Style

Rahman, N, et al. “Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection.” New England Journal of Medicine, vol. 365, no. 6, 2011, pp. 518–26.

Chicago Style

Rahman, N, N Maskell, A West, et al. 2011. “Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection.” New England Journal of Medicine 365 (6): 518–26.
Print