Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
Chest. 2021 Aug;160(2):776-783. doi: 10.1016/j.chest.2021.03.023. Epub 2021 Mar 18.
Indwelling tunneled pleural catheters (IPCs) are used regularly for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (ie, alteplase) to restore flow. The safety profile of intrapleural medications has been reported previously; however, most studies exclude anticoagulated patients.
What is the safety profile of intrapleural alteplase, dornase alfa, or both when used in patients with IPCs, including in those who may be undergoing active anticoagulation?
Retrospective review of patients with previously placed IPCs from January 2009 through February 2020 undergoing intrapleural alteplase therapy. Basic demographics, laboratory studies, anticoagulation medication use, and complications were collected. Descriptive statistics were used to report demographics and outcomes. Univariate Firth's logistic regression analyses were used to identify factors associated with complications, followed by multivariate regression analyses.
A total of 94 patients underwent IPC placement and intrapleural instillation. The median age of patients was 66.1 years (interquartile range, 57.6-74.9 years). Intrapleural medications were administered 71 times in 30 anticoagulated patients and 172 times in 64 patients who were not anticoagulated. A total of 20 complications were identified in 18 patients, with one patient experiencing more than one complication. Five bleeding complications occurred with no significant increased risk with anticoagulation use (in 2 anticoagulated patients and 3 patients who were not anticoagulated; P = .092). Multivariate Firth's logistic regression demonstrated that alteplase dose (P = .04) and anticoagulation use (P = .05) were associated with any complication, but were not associated with bleeding complications.
We report a relatively low incidence of complications and, in particular, bleeding complications in patients receiving intrapleural alteplase for nondraining IPCs. Bleeding episodes occurred in five of 94 patients (5.3%) with no apparent increased risk of bleeding complication, regardless of whether receiving anticoagulation. Additional study is warranted to identify risk factors for complications, in particular bleeding complications, in this patient population.
留置隧道式胸腔引流管（IPC）常用于复发性胸腔积液的管理。导管阻塞并不罕见，通常需要胸腔内药物滴注（即，阿替普酶）来恢复引流。胸腔内药物的安全性已被先前报道；然而，大多数研究排除了正在接受抗凝治疗的患者。
当在留置 IPC 的患者中使用胸腔内阿替普酶、脱氧核糖核酸酶 α 或两者时，安全性如何，包括那些可能正在接受抗凝治疗的患者？
回顾性分析 2009 年 1 月至 2020 年 2 月期间接受胸腔内阿替普酶治疗的既往置管 IPC 的患者。收集基本人口统计学、实验室研究、抗凝药物使用和并发症等数据。使用描述性统计方法报告人口统计学和结局。使用单变量 Firth 逻辑回归分析识别与并发症相关的因素，然后进行多变量回归分析。
共有 94 例患者接受了 IPC 置管和胸腔内滴注。患者的中位年龄为 66.1 岁（四分位间距，57.6-74.9 岁）。30 例抗凝治疗患者共进行了 71 次胸腔内药物滴注，64 例未抗凝患者共进行了 172 次胸腔内药物滴注。18 例患者共发生 20 例并发症，其中 1 例患者发生 1 次以上并发症。5 例出血并发症发生，抗凝治疗使用无显著增加出血风险（2 例抗凝治疗患者和 3 例未抗凝治疗患者；P=0.092）。多变量 Firth 逻辑回归显示，阿替普酶剂量（P=0.04）和抗凝治疗使用（P=0.05）与任何并发症相关，但与出血并发症无关。
我们报告了接受胸腔内阿替普酶治疗非引流性 IPC 的患者相对较低的并发症发生率，特别是出血并发症发生率。5 例患者发生 5 例出血并发症（5.3%），尽管正在接受抗凝治疗，但出血并发症的风险似乎没有增加。需要进一步研究以确定该患者人群中并发症，特别是出血并发症的风险因素。
