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Evidence summaries

Intra-Pleural Fibrinolytic Therapy in Parapneumonic Effusions and Empyema

Intrapleural fibrinolytic therapy may reduce the need for surgical interventions in adult patients with parapneumonic effusions or empyema. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 7 studies with a total of 761 subjects having presented with parapneumonic effusion only (5 studies) or with parapneumonic effusions and empyema (2 studies). The only consistent end points in all trials were treatment failure, as gauged by the requirement for additional intervention including surgery or death. In studies where patients had either loculation and empyema, there was no significant difference in the risk of death with fibrinolytics (RR 1.08; 95% CI 0.69 to 1.68). When treatment failure was considered as surgical intervention, fibrinolytics reduced the risk of this outcome (RR 0.63; 95% CI 0.46 to 0.85), but there is discordance between earlier positive studies and the more recent negative study by Maskell.

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by imprecise results (limited study size for each comparison).

    References

    • Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008 Apr 16;(2):CD002312. [PubMed]

Primary/Secondary Keywords