Comparison of Clinical Efficacy between Alteplase 0.1 mg/kg and 4 mg for Complicated Parapneumonic Effusion in Children

Abstract

Background: Intrapleural alteplase for the treatment of complicated parapneumonic effusion has been shown to reduce the surgical rate, duration of hospitalization, and time to defervescence, and improve pleural fluid drainage. However, there are various regimens of alteplase administration. Objective: To compare the efficacy and safety between intrapleural alteplase 0.1 mg/kg and 4 mg in the management of complicated parapneumonic effusion. Materials and Methods: An observational historical cohort study was conducted in patients aged between three months and 15 years diagnosed with complicated parapneumonic effusion or empyema thoracis. The patients were divided into two groups. The first group was patients enrolled between January 2012 and December 2019 and receiving alteplase 4 mg/dose. The second group was patients were enrolled between April 2020 and March 2021 and receiving alteplase 0.1 mg/kg/dose with a maximum of 4 mg. Intrapleural alteplase was given once a day for three consecutive days. Baseline characteristic, clinical outcome, adverse effect, and treatment costs were recorded. The data were statistically analyzed. Results: Thirty patients were enrolled with 20 in the 4 mg group and 10 in the 0.1 mg/kg group. There were no significant differences between the two groups with regards to treatment success rate, time to defervescence, and total pleural fluid drainage. One patient in the 0.1 mg/kg group required surgical treatment. Patients in the 0.1 mg/kg group had significantly shorter duration of hospitalization at 10 versus 13 days (p=0.03) and lower costs of treatment compared with the 4 mg group at 15,388.50 versus 22,214.75 Baht (p=0.03). Intrapleural bleeding was found in one patient in the 4 mg/dose group. Conclusion: Intrapleural alteplase in the dose of 0.1 mg/kg and that of 4 mg have good clinical efficacy for treatment of complicated parapneumonic effusion. The 0.1 mg/kg group is safe and associated with lower cost of treatment, and shorter hospital stays. Keywords: Intrapleural alteplase; Tissue plasminogen activator; Complicated parapneumonic effusion