Oh Jeong Suk, Yoo Chris, Wong Donny
Department of Respiratory Medicine North Shore hospital Auckland New Zealand.
Respirol Case Rep. 2023 Aug 9;11(9):e01202. doi: 10.1002/rcr2.1202. eCollection 2023 Sep.
Alteplase as a fibrinolytic can be used to break up fibrin to encourage clot breakdown for clinical use. In the pleural space, it is used for symptomatic loculated malignant pleural effusions and pleural infections and can potentially avoid the need for surgical intervention. The optimal dose and dosing regimen of intrapleural fibrinolytics is still unknown. Although generally considered safe, bleeding is a serious potential complication and studies are ongoing to try and determine the lowest effective dose of alteplase to successfully treat pleural infections. This case highlighted the safe use of very low doses of alteplase ranging from 0.25 to 0.5 mg following pleural bleeding after the use of alteplase to treat a patient with symptomatic malignant loculated effusion. It demonstrates once pleural bleeding has stopped, there is a role for carefully titrated intrapleural alteplase use to avoid surgery.
阿替普酶作为一种纤溶剂，可用于分解纤维蛋白以促进血栓溶解，供临床使用。在胸腔内，它用于治疗有症状的局限性恶性胸腔积液和胸腔感染，并且有可能避免手术干预。胸腔内纤溶剂的最佳剂量和给药方案仍不明确。尽管一般认为是安全的，但出血是一种严重的潜在并发症，目前正在进行研究，试图确定成功治疗胸腔感染的阿替普酶最低有效剂量。该病例突出显示了在使用阿替普酶治疗一名有症状的局限性恶性胸腔积液患者后发生胸腔出血，使用0.25至0.5毫克的极低剂量阿替普酶的安全情况。它表明一旦胸腔出血停止，谨慎滴定使用胸腔内阿替普酶可避免手术。
