Intrapleural Fibrinolysis in Posttubercular Loculated Pleural Effusions at a TertiaryCare Respiratory Center: An Uncontrolled Blinded BeforeAfter Intervention Study

Background: Tuberculous, parapneumonic and traumatic loculated pleuraleffusions pose therapeutic challenges due to resultant pleuralthickening and compromised lungfunction for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleuraleffusion to reduce the burden and sequelae. Objective: An uncontrolled and blind beforeafter intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiarycare respiratory center after obtaining approval and written informed consent. Methods: Fiftyone patients with loculated pleural effusion were administered with repeated cycles of three doses of 1 Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre and postIPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The KolmogorovSmirnov test and paired t test with significance at a P value less than 0.05 were applied to test statistically significant differences in proportions and means, respectively. Results: Tuberculosis was the most common etiology leading to loculated pleural effusion (80%), and 82.4% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in 80.4% of patients. Chest pain (13.7%) and fever (9.8%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre and postIPFT from 184±81 ml to 67±52 ml was observed. Conclusion: IPFT with urokinase is an effective treatment modality in patients with posttubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function.