tPA, DNase Improves Fluid Drainage in Pleural Infection

Tissue plasminogen activator and DNase therapy reduces surgical referral frequency, hospital stay

THURSDAY, Aug. 11 (HealthDay News) -- Combined intrapleural tissue plasminogen activator (t-PA) and DNase therapy improves fluid drainage in patients with pleural infection and reduces hospital stay duration and the frequency of surgical referral, according to a study published in the Aug. 11 issue of the New England Journal of Medicine.

Najib M. Rahman, D.Phil., from the Churchill Hospital in Oxford, U.K., and colleagues investigated whether use of intrapleural t-PA and DNase improved fluid drainage in 210 patients with pleural infection who received one of four treatments for three days: double placebo; t-PA and DNase; t-PA and placebo; or DNase and placebo. Change in pleural opacity was the primary outcome measure, and secondary outcomes included referral for surgery, hospital stay duration, and adverse events.

The investigators found a significantly greater mean change in pleural opacity in the t-PA-DNase group compared to the placebo group (−29.5 versus −17.2 percent). The changes with t-PA alone and with DNase alone (−17.2 and −14.7 percent, respectively) were not significantly different from the placebo group. Compared to the placebo group, the frequency of surgical referral at three months was significantly lower in the t-PA-DNase group (4 versus 16 percent; odds ratio [OR], 0.17), but it was significantly greater in the DNase group (39 percent; OR, 3.56). Compared to the placebo group, the combined t-PA-DNase therapy was associated with reduced hospital stay, but t-PA alone and DNase alone were not significantly different from placebo. There were no significant differences in the frequency of adverse events between the groups.

"Intrapleural t-PA-DNase therapy improved fluid drainage in patients with pleural infection," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry. The study was partially supported by an unrestricted educational grant from Roche UK.

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Physician’s Briefing Staff

Physician’s Briefing Staff

Published on August 11, 2011

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