Abstract
Background: Intrapleural enzyme therapy (IET) with tissue plasminogen activator and deoxyribonuclease has been established as a therapeutic option in pleural infection. Despite data[1] demonstrating efficacy, a recent intrapleural fibrinolytic metanalysis[2] concluded a need for additional data to evaluate safety. Limited studies specifically address bleeding complications.
Aim: To assess the overall bleeding risk associated with IET in a real-world setting, and specifically evaluate the effects of concurrent anticoagulation (AC).
Methods: 1825 patients with pleural infection treated with IET were recruited from 25 centres between 2012 and 2018. Pleural bleed was predefined as a change in pleural fluid Hct ≥50% serum Hct or 25-50% serum Hct with clinical suspicion. Pearson’s chi squared test was used to determine statistical significance.
Results: The overall incidence of pleural bleeding was 4.2% (n=76; 95% CI 0.03-0.05). Receiving therapeutic AC on admission (17.3%; n=315) was associated with an increased bleeding risk (3.6% vs 7.0%) [p=0.001]; OR=0.52(95% CI 0.32–0.84). Concomitant administration of AC with IET (10.8%; n=197) was associated with a significantly increased bleeding risk compared to withholding AC for 2 days (median duration) prior to IET administration (9.6% vs. 37.2%) [p=0.003]; OR=0.25 (95% CI 0.07-0.85).
Conclusion: This is the largest study to date of IET use in pleural infection and confirms the low bleeding risk reported in MIST-2(3.8%). Although bleeding risk was increased with concurrent AC, suspension prior to IET appears to reduce this risk significantly suggesting concomitant administration of IET and therapeutic AC should be avoided.
Footnotes
Cite this article as: European Respiratory Journal 2021; 58: Suppl. 65, OA239.
This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2021