Safety and efficacy of intrapleural tpa and doranse for complicated pleural infection

SESSION TITLE: Complicated Pleural Effusions SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:44 pm PURPOSE: The concurrent intrapleural instillation of Tissue Plasminogen Activator (tPA) and dornase-alpha (tPA/dornase) is often used in patients with complicated pleural infections. There is limited data on the rate of adverse effects including increased bleeding, mortality, rate of surgical referral, or readmission with patients that received concurrent tPA/Dornase. Here we present a retrospective review of patients treated intrapleural tPA/dornase, looking specifically for bleeding at our institutions. At our two-hospital system, the standard protocol for administration of intrapleural tPA/dornase 10mg/5mg intrapleural via clamped chest tube for 1 hour, every 12 hours for 6 doses or until effusion resolution. METHODS: Using a combination of billing and coding data and inpatient pharmacy data we identified patients who received intrapleural administration of tPA/dornase at either of our two hospitals from 2014 to 2018. Under the IRB approved protocol 143 patients were identified. Charts were reviewed to confirm indication and administration of tPA/dornase and assess for the rates of major and non-major bleeding. One-hundred charts were excluded due to non-pleural administrate of tPA/dornase or non-infection related indication for pleural tPA. Major bleeding defined as intracranial hemorrhage, hemorrhage resulting in hemorrhagic shock, or death. Non-major bleeding was defined as bleeding requiring transfusion and or the decision to discontinue additional doses of intrapleural tPA/dornase. Transfusions given for down trending hemoglobin but tPA/dornase was continued for the full 6 doses was not counted as significant bleeding. The total number of administered doses, rate of successful catheter-based drainage, rate surgical referral, and rate of inpatient death were recorded. RESULTS: A total of 43 patient who received intrapleural tPA/dornase were identified, patients received a mean and median of 4.67 and 6 doses respectively. We did not identify any cases of major bleeding, but did identify 3 cases of non-major bleeding, which resulted in the termination of therapy. One case of non-major bleeding occurred following CPR from PEA arrest that was felt to be related to septic shock. No transfusions were administered; thus this was not considered major bleeding. The overall success rate of catheter-based drainage with tPA/dornase was 86%, the rate of surgical management was 13.9%. There were no inpatient deaths that occurred, though 4 patients died within 30 days of admission due to comorbid conditions. CONCLUSIONS: The concomitant use of intrapleural tPA/dornase at our institution has a high rate of clinical success similar to that of reported in the literature, with acceptable rate of hemorrhagic complications. CLINICAL IMPLICATIONS: The use of concomitant intrapleural tPA/dornase for complicated pleural infections is a reasonable practice. DISCLOSURES: No relevant relationships by Kevin Proud No relevant relationships by Abraham Rodriguez No relevant relationships by John Suder