Intrapleural tissue plasminogen activator for complicated pleural effusions

J Trauma. 2004 Dec;57(6):1178-83. doi: 10.1097/01.ta.0000141879.67441.52.


Background: This study is aimed at evaluating the safety and efficacy of intrapleural tissue plasminogen activator (TPA) for complicated pleural effusions, including posttraumatic hemothorax.

Methods: Data were retrospectively collected from hospitalized patients over a 4-year period (1999-2003) who were treated with intrapleural TPA after failing drainage by tube thoracostomy. Pre- and post-TPA imaging studies were reviewed and scored by a blinded radiologist.

Results: Forty-one consecutive patients with 42 effusions were identified with the following indications: 6 traumatic hemothoraces (14%), 22 loculated pleural effusions (52%), 2 line-associated hemothoraces (5%), and 12 empyemas (29%). Nine patients (22%) required operative drainage including two with posttraumatic hemothoraces. All patients managed nonoperatively demonstrated radiographic improvement after TPA administration. One patient (2.4%) developed hematuria, requiring transfusion. No trauma patient required TPA-related blood transfusion and no deaths were attributable to TPA therapy.

Conclusion: Intrapleural TPA administration appears safe for use in complicated pleural effusions and may decrease the need for operative intervention.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Comorbidity
  • Empyema, Pleural / drug therapy
  • Empyema, Pleural / etiology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Pleural Effusion / complications
  • Pleural Effusion / drug therapy*
  • Pleural Effusion / epidemiology
  • Pneumothorax / drug therapy
  • Pneumothorax / etiology
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator