Purpose: To determine if alteplase infusion for the treatment of loculated abdominopelvic abscesses requiring percutaneous catheter drainage was superior to saline solution infusion.
Methods and materials: This study was a single-center prospective randomized trial. Patients with loculated abdominopelvic abscesses unsuccessfully drained by initial catheter placement were randomized to receive the fibrinolytic agent alteplase or normal saline solution. The amount of alteplase used to treat abscesses was 2 mg or 4 mg based on infusion volumes of 0-50 mL or 51-100 mL, respectively. Infusions were administered twice daily for 3 days. Computed tomography was performed before initiation of therapy and immediately after 3 days of infusions. Success was defined by removal of the catheter after drainage without recurrent abscess or surgical intervention within 30 days.
Results: A total of 20 patients were included in this study: 11 received alteplase and nine received normal saline solution. There was no significant difference in the distribution of sex (P = .08) or age (P = .29). Abscess resolution was achieved in nine of 11 alteplase-treated patients (80%) versus three of nine saline solution-treated patients (33%). However, one patient in each group required repeat intervention within 30 days, for overall success rates of 73% versus 22%, respectively (P = .02). Having observed a significant difference in the primary outcome variable, the study was terminated early.
Conclusions: A 3-day course of twice-daily alteplase infusion therapy is superior to normal saline solution for the treatment of loculated abdominopelvic abscesses.