TY - JOUR ID - 60716 TI - Intrapleural Fibrinolysis in Post-tubercular Loculated Pleural Effusions at a Tertiary-Care Respiratory Center: An Uncontrolled Blinded Before-After Intervention Study JO - Hospital Practices and Research JA - HPR LA - en SN - 2476-390X AU - Subramanian, Narayanan AU - Bhattacharyya, Debajyoti AU - Khan, Inam Danish AU - Prasad, Vishnu AU - Kotaru, Arun AU - Vardhan, Vasu AU - Pandya, Kapil AD - Army College of Medical Sciences and Base Hospital, New Delhi, India AD - Army Hospital Research and Referral, New Delhi, India AD - Venkateshwara Hospital, Dwarka, New Delhi, India AD - Armed Forces Medical College, Pune, India Y1 - 2018 PY - 2018 VL - 3 IS - 2 SP - 59 EP - 63 KW - Tuberculosis KW - Intrapleural Fibrinolytic Therapy KW - Pleural Effusion KW - Urokinase DO - 10.15171/hpr.2018.12 N2 - Background: Tuberculous, parapneumonic and traumatic loculated pleural-effusions pose therapeutic challenges due to resultant pleural-thickening and compromised lung-function for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleural-effusion to reduce the burden and sequelae. Objective: An uncontrolled and blind before-after intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiary-care respiratory center after obtaining approval and written informed consent. Methods: Fifty-one patients with loculated pleural effusion were administered with repeated cycles of three doses of 1 Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre- and post-IPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The Kolmogorov-Smirnov test and paired t test with significance at a P value less than 0.05 were applied to test statistically significant differences in proportions and means, respectively. Results: Tuberculosis was the most common etiology leading to loculated pleural effusion (80%), and 82.4% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in 80.4% of patients. Chest pain (13.7%) and fever (9.8%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre- and post-IPFT from 184±81 ml to 67±52 ml was observed. Conclusion: IPFT with urokinase is an effective treatment modality in patients with post-tubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function. UR - https://www.jhpr.ir/article_60716.html L1 - https://www.jhpr.ir/article_60716_913555d0fefa13cd7dcc8d9d4d6c97a8.pdf ER -