INTRAPLEURAL TISSUE PLASMINOGEN ACTIVATOR AND DEOXYRIBONUCLEASE THERAPY VS EARLY MEDICAL THORACOSCOPY FOR TREATMENT OF PLEURAL INFECTION: A RANDOMIZED CLINICAL TRIAL

Abstract

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 02:15 pm - 03:15 pm PURPOSE: Pleural infection is a frequent clinical diagnoses encountered in clinical practice associated with high morbidity and mortality. There is limited evidence regarding the optimal treatment of this condition especially in complicated effusions with septa. Although both early medical thoracoscopy (MT) and tube thoracostomy with intrapleural instillation of tissue plasminogen activator (tPA) and human recombinant deoxyribonuclease (DNase) are acceptable treatment for patients with complicated pleural infection, there is a lack of comparative data between these modes of management. The aim of this study is to compare the safety and efficacy of early MT versus intrapleural (tPA/DNase) in patients with complicated pleural infection. METHODS: Interim analysis of a prospective multicenter randomized control trial of patients with pleural infection and evidence of septated pleural effusion on pleural ultrasonography and/or chest computed tomography scan who underwent MT or chest thoracostomy with instillation of tPA/DNase. The primary outcome was the length of hospital stay following either intervention. Secondary outcomes included treatment success, number of days of chest tube drainage, cost and adverse events. RESULTS: A total of 12 patients with pleural infection were included so far: 6 in each group (Table 1). In the tPA/DNase group: the median length of hospital stay following intervention was 5 (range, 5- 8), the median number of doses of tPA/DNase was 5 (range, 2-6), median chest drainage days was 4 (range, 2- 7), therapy was successful in 66.6% (4/6) with 2 patients requiring insertion of additional chest tubes. In the MT group: the median length of hospital stay following intervention was 2 (range, 2-13), median chest drainage days was 2 (range, 1-3), therapy was successful in 83.3% (5/6) with 1 patient requiring a single dose of tPA/DNase. In both groups, there was neither pleural bleeding that required transfusion nor mortality related to pleural infection. The overall cost of MT was 9,700$ while the cost of 5 doses of tPA/DNase was 15,000$. CONCLUSIONS: This interim analysis showed that early MT decreased length of hospital stay and overall cost following intervention as compared to tPA/DNase therapy in patients with complicated pleural infection. CLINICAL IMPLICATIONS: Early medical thoracoscopy might shorten hospital stay and cost in patients with complicated pleural infection as compared with tPA/DNase therapy. DISCLOSURES: Consultant relationship with Boston Scientific Please note: $1-$1000 Added 03/02/2018 by Alex Chee, source=Web Response, value=Consulting fee No relevant relationships by Upendra Kaphle, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $5001 - $20000 Added 03/04/2018 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with Olympus Please note: $5001 - $20000 Added 03/04/2018 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Hiren Mehta, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Estefania Rivera, source=Web Response No relevant relationships by Sanket Thakore, source=Web Response