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Bleeding Risk With Combination Intrapleural Fibrinolytic and Enzyme Therapy in Pleural Infection: An International, Multicenter, Retrospective Cohort Study.
Akulian, Jason; Bedawi, Eihab O; Abbas, Hawazin; Argento, Christine; Arnold, David T; Balwan, Akshu; Batra, Hitesh; Uribe Becerra, Juan Pablo; Belanger, Adam; Berger, Kristin; Burks, Allen Cole; Chang, Jiwoon; Chrissian, Ara A; DiBardino, David M; Fuentes, Xavier Fonseca; Gesthalter, Yaron B; Gilbert, Christopher R; Glisinski, Kristen; Godfrey, Mark; Gorden, Jed A; Grosu, Horiana; Gupta, Mridul; Kheir, Fayez; Ma, Kevin C; Majid, Adnan; Maldonado, Fabien; Maskell, Nick A; Mehta, Hiren; Mercer, Joshua; Mullon, John; Nelson, Darlene; Nguyen, Elaine; Pickering, Edward M; Puchalski, Jonathan; Reddy, Chakravarthy; Revelo, Alberto E; Roller, Lance; Sachdeva, Ashutosh; Sanchez, Trinidad; Sathyanarayan, Priya; Semaan, Roy; Senitko, Michal; Shojaee, Samira; Story, Ryan; Thiboutot, Jeffrey; Wahidi, Momen; Wilshire, Candice L; Yu, Diana; Zouk, Aline; Rahman, Najib M.
Affiliation
  • Akulian J; Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Carolina Center for Pleural Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
  • Bedawi EO; Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, England; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, England. Electronic address: eihab.bedawi@ouh.nhs.uk.
  • Abbas H; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
  • Argento C; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Arnold DT; Division of Pulmonary and Critical Care, Duke University, Durham, NC.
  • Balwan A; Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
  • Batra H; Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL.
  • Uribe Becerra JP; Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
  • Belanger A; Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
  • Berger K; Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY.
  • Burks AC; Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Carolina Center for Pleural Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
  • Chang J; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA.
  • Chrissian AA; Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA.
  • DiBardino DM; Section of Interventional Pulmonology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Fuentes XF; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  • Gesthalter YB; Division of Pulmonary, Critical Care, Allergy and Sleep, The University of California San Francisco, San Francisco, CA.
  • Gilbert CR; Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Center for Lung Cancer Research in Honor of Wayne Gittinger, Seattle, WA.
  • Glisinski K; Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO.
  • Godfrey M; Division of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT.
  • Gorden JA; Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Center for Lung Cancer Research in Honor of Wayne Gittinger, Seattle, WA.
  • Grosu H; Division of Pulmonary and Critical Care, The University Texas MD Anderson Cancer Center, Houston, TX.
  • Gupta M; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS.
  • Kheir F; Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
  • Ma KC; Section of Interventional Pulmonology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Majid A; Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
  • Maldonado F; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Maskell NA; Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, England.
  • Mehta H; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
  • Mercer J; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Mullon J; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  • Nelson D; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
  • Nguyen E; Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA.
  • Pickering EM; Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
  • Puchalski J; Division of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT.
  • Reddy C; Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT.
  • Revelo AE; Interventional Pulmonology Section, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
  • Roller L; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Sachdeva A; Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
  • Sanchez T; Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA.
  • Sathyanarayan P; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Semaan R; Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
  • Senitko M; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS.
  • Shojaee S; Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA.
  • Story R; Interventional Pulmonology Section, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
  • Thiboutot J; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Wahidi M; Division of Pulmonary and Critical Care, Duke University, Durham, NC.
  • Wilshire CL; Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Center for Lung Cancer Research in Honor of Wayne Gittinger, Seattle, WA.
  • Yu D; Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
  • Zouk A; Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL.
  • Rahman NM; Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, England; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, England.
Chest ; 162(6): 1384-1392, 2022 Dec.
Article in En | MEDLINE | ID: mdl-35716828
BACKGROUND: 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. RESEARCH QUESTION: What is the bleeding complication risk associated with IET use in pleural infection? STUDY DESIGN AND METHODS: 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. RESULTS: 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. INTERPRETATION: 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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pleural Diseases / Pleural Effusion / Communicable Diseases / Empyema, Pleural Type of study: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Chest Year: 2022 Document type: Article Country of publication: United States
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pleural Diseases / Pleural Effusion / Communicable Diseases / Empyema, Pleural Type of study: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Chest Year: 2022 Document type: Article Country of publication: United States