Portal de Periódicos da CAPES

Bleeding Risk With Combination Intrapleural Fibrinolytic and Enzyme Therapy in Pleural Infection

2022; Elsevier BV; Volume: 162; Issue: 6 Linguagem: Inglês

10.1016/j.chest.2022.06.008

1931-3543

Jason Akulian, Eihab O. Bedawi, Hawazin Abbas, Christine Argento, David Arnold, Akshu Balwan, Hitesh Batra, Juan Pablo Uribe Becerra, Adam Belanger, Kristin Berger, Allen Cole Burks, Jiwoon Chang, Ara A. Chrissian, David M. DiBardino, Xavier Fonseca Fuentes, Yaron Gesthalter, Christopher R. Gilbert, Kristen Glisinski, Mark Godfrey, Jed A. Gorden, Horiana B. Grosu, Mridul Gupta, Fayez Kheir, C. Kevin, Adnan Majid, Fabien Maldonado, Nick Maskell, Hiren J. Mehta, Joshua Mercer, John J. Mullon, Darlene R. Nelson, Elaine Nguyen, Edward M. Pickering, Jonathan Puchalski, Chakravarthy Reddy, Alberto Revelo, Lance Roller, Ashutosh Sachdeva, Trinidad Sánchez, Priya Sathyanarayan, Roy Semaan, Michal Šenitko, Samira Shojaee, R. Story, Jeffrey Thiboutot, Momen M. Wahidi, Candice L. Wilshire, Diana Yu, Aline N. Zouk, Najib M. Rahman, Lonny Yarmus,

Pneumothorax, Barotrauma, Emphysema

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.What is the bleeding complication risk associated with IET use in pleural infection?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.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 × 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.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.