Pleural Space Diseases and Their Management: What is the Role of Intrapleural Fibrinolytic Therapy?

Pleural space diseases are a significant cause of morbidity in the United States with a reported 25% mortality rate within a year of diagnosis. Pleural space diseases, including intrapleural infections, retained hemothorax (RH), and malignant pleural effusions (MPE), often indicate advanced disease. Despite options like video-assisted thoracoscopy (VATS), tube thoracostomy, and intrapleural fibrinolytic therapy (IPFT), treatment remains a significant clinical challenge. IPFT, which describes a combination of administrating tissue plasminogen activator (tPA) and DNase through a chest tube, has shown effectiveness in improving fluid drainage and reducing surgery frequency in a large, randomized control trial and is widely used. However, the success of IPFT varies based on infection severity, patient health, and treatment timing, with a failure rate around 20-25%. This highlights the need for further research to enhance the therapy's efficacy, investigating both disease mechanisms and optimizing treatment protocols. This review seeks to provide a comprehensive overview of IPFT, highlighting recent advancements, current trends, and existing research gaps.