Intrapleural fibrinolytics in management of empyema thoracis

Study objective: To determine the success and complication rates of fibrinolytic therapy (FL) in the treatment of thoracic empyema. Design and patients: Between December 1992 and November 1994, all patients referred with empyema thoracis (ET) were offered FL. FL consisted of streptokinase (275,000±170,000 IU) or urokinase (121,000±57,000 IU) daily for a mean of 6.2±2.1 days. Setting: The University of New Mexico Health Sciences Center and the Albuquerque Veterans Affairs Medical Center. Results: Twenty-six patients were treated. Sixty-two percent (16/26) had complete resolution (CR) of symptoms, near or complete normalization of chest radiographic findings, and required no surgery or empyema tubes. Eight percent (2/26) had relief of symptoms and partial resolution (PR) of radiographic abnormalities and were discharged from the hospital with empyema tubes in place. All patients with PR had empyema tubes removed within 30 days of hospital discharge. Thirty- one percent (8/26) of patients failed to completely improve clinically or radiographically (nonresponse) and were treated with decortication or empyema tubes for greater than 30 days. Bleeding occurred in a single patient (4%). There was no mortality associated with FL use. Conclusions: The use of FL is associated with resolution of ET in 69% (18/26) of patients. This modality is safe, effective, and spares most patients with empyema the morbidity and mortality of thoracotomy.