Intra-pleural Fibrinolytic Therapy for Treatment of Adult Parapneumonic Effusions and Empyemas: A Systematic Review and Meta-analysis.
Chest. 2012 Mar 29;
Authors: Janda S, Swiston J
AbstractBackgroundThe purpose of our study was to conduct a systematic review and meta-anlaysis of all randomized controlled trials to date comparing fibrinolytics to placebo in order to clarify their current role in the management of parapneumonic effusions and empyemas.MethodsMEDLINE, EMBASE, PapersFirst, and the Cochrane collaboration and the Cochrane Register of controlled trials were searched. All searches were inclusive as of October 2011. Two investigators independently reviewed articles and extracted data. Quality was assessed with the Cochrane concealment of allocation approach and the Jadad criteria.ResultsSeven randomized controlled studies (total number of patients 801) comparing fibrinolytic therapy to placebo were included in the meta-analysis. Fibrinolytic therapy was beneficial for the outcomes of treatment failure (surgical intervention or death) [RR 0.50 (95% CI: 0.28-0.87)] and surgical intervention alone [RR 0.61 (95% CI: 0.45-0.82)]. There was no difference in mean duration of hospital stay [SMD -0.69 (95% CI: -1.54-0.16)] and death [RR 1.14 (95% CI: 0.74-1.74)].ConclusionsThis meta-analysis does reveal that fibrinolytic therapy is potentially beneficial in the management of parapneumonic effusions and empyemas in the adult population. Although there is insufficient evidence to support the routine use of this therapy for all parapneumonic effusions/empyemas, fibrinolytic therapy may be considered in patients with loculated pleural effusions, as it may prevent the need for surgical intervention. Further randomized controlled trials with adequate power are needed to definitively address the effect of fibrinolytics and the combination of fibrinolytics and DNase on clinical outcomes outlined in this analysis in patients with parapneumonic effusions/empyemas.
PMID: 22459772 [PubMed - as supplied by publisher]