Comparison of the Efficacies of Alteplase and Streptokinase Used for Fibrinolytic Treatment in Parapneumonic Pleural Effusion and Empyema

ABSTRACT Introduction: Used rarely in the fibrinolytic treatment of parapneumonic pleural effusion (PPE) and empyema, alteplase is a plasminogen activator (tPA) analogue. Objective: In our study, we divided the patients with PPE and empyema, to whom we implemented video-assisted thoracic surgery, into two groups and we implemented VATS to one group and alteplase plus fibrinolysis following VATS to the other. We compared these two groups through clinical and biochemical parameters. Methods: Totally 66 patients were involved in the study. The patients were divided into 2 groups randomly. 5-20 mg alteplase was administered to 40 patients in the first group (Alteplase) through tube thoracostomy following VATS. And only VATS was implemented to 26 patients in the second group (Control). The chest tube removal times of the patients and their lengths of hospitalization, C-Reactive Protein (CRP) and White Blood Cells (WBC) values were compared statistically. Results: It was determined that the groups were homogeneous statistically (P>0.05), CRP values (11.99±9.63) in the alteplase group were statistically significantly higher comparing to the control (4.07±5.10) group (P<0.05), Alteplase group was better in the comparison of the removal times of chest tubes, lengths of hospitalization and WBC values, however the findings were not statistically significant (P>0.05). Conclusion: Alteplase is a significantly efficient fibrinolytic treatment with a success rate of 87.5%, which can be used in PPE and empyema with minimum side effects in appropriate dosages. Keyswords: Alteplase, Streptokinase, Fibrinolytic Treatment, Parapneumonic Pleural Effusion, Empyema.