From the Guidelines
Alteplase is used in a chest drain to break down and dissolve blood clots that cause pleural space occlusions, particularly in cases of complicated pleural effusions or hemothorax, as evidenced by a prospective study showing a 72% clinical success rate compared to 22% for patients receiving sterile saline 1. The purpose of using alteplase in a chest drain is to facilitate the drainage of complex, multiseptated fluid collections that are refractory to percutaneous catheter drainage (PCD) by intracavitary instillation of fibrinolytic agents.
- The use of alteplase has been reported to have high rates of clinical success in retrospective studies for abdominal and pelvic abscesses, as well as organizing hemothorax and empyema 1.
- A prospective study of 20 patients with complicated intra-abdominal abscesses showed that patients receiving intracavitary alteplase had a 72% clinical success rate compared to 22% for patients receiving sterile saline 1.
- The rates of bleeding complications using intracavitary recombinant tissue plasminogen activator have been low to zero for pelvic, abdominal, and chest collections, except for a 33% rate of pleural hemorrhage noted for intrapleural recombinant tissue plasminogen activator for patients on anticoagulation 1. The typical dosing regimen involves instilling 4-10 mg of alteplase diluted in 50-100 mL of normal saline directly into the pleural space through the chest tube, which is then clamped for 1-4 hours to allow the medication to work before unclamping to restore drainage.
- This procedure may be repeated daily for up to three days if needed, and the patient should be monitored for signs of hemorrhage, with caution used in patients with bleeding disorders or recent surgery 1.
From the Research
Purpose of Alteplase in Chest Drain
- Alteplase, also known as tissue plasminogen activator, is used to stimulate fibrinolysis of blood thrombi by converting plasminogen to plasmin 2.
- The use of alteplase in a chest drain is related to its ability to dissolve blood clots, which can accumulate in the chest cavity and cause complications such as pulmonary embolism.
- Studies have shown that alteplase can be effective in treating pulmonary embolism, with reduced mortality and recurrence rates compared to anticoagulants alone 3, 4.
Mechanism of Action
- Alteplase works by activating the conversion of plasminogen to plasmin, which then breaks down fibrin clots 2.
- This mechanism of action makes alteplase a useful agent for dissolving blood clots in the chest cavity, which can help to improve patient outcomes.
Comparison with Other Thrombolytic Agents
- Alteplase has been compared to other thrombolytic agents, such as streptokinase and urokinase, in terms of its efficacy and safety 3, 5, 6.
- While streptokinase and urokinase may have their own advantages and disadvantages, alteplase has been shown to be a effective and safe option for treating pulmonary embolism 3, 4.