From the Research
Safety of Anticoagulation with TPA and Dornase for Empyema
- The safety of anticoagulation with TPA (tissue plasminogen activator) and dornase (Pulmozyme) for empyema has been studied in several research papers 1, 2, 3, 4.
- A pilot study published in 2021 found that the intrapleural administration of dornase alfa and tissue plasminogen activator was safe in children with empyema, with no serious adverse events or bleeding complications reported 1.
- Another study published in 2022 reported the successful use of t-PA and DNase in a patient with a multiloculated recurrent malignant pleural effusion, with no adverse events noted 2.
- A retrospective cohort study published in 2020 found that concurrent once daily administration of tPA and DNase in patients with pleural infection yielded comparable rates of treatment success, but highlighted potential safety concerns with adverse events such as bleeding 3.
- A study protocol published in 2017 outlined a randomized controlled trial to assess the safety and effectiveness of combined treatment with dornase alfa and fibrinolytics compared to fibrinolytics alone for the treatment of empyema in children 4.
- However, a study published in 2025 compared low-dose systemic tPA to conventional anticoagulation for the treatment of intermediate-high risk pulmonary embolism, and found that low-dose tPA may be an effective and safe therapy, but this study did not specifically address the use of TPA and dornase for empyema 5.
Bleeding Risks and Anticoagulation
- The risk of bleeding with anticoagulation and TPA and dornase therapy is a concern, with one study reporting significant pleural bleeding requiring transfusion therapy in 8.9% of patients 3.
- However, another study found that low-dose tPA may be associated with fewer bleeding events compared to conventional anticoagulation 5.
- The safety of anticoagulation with TPA and dornase for empyema requires careful consideration of the potential benefits and risks, and further research is needed to fully understand the safety profile of this therapy 1, 2, 3, 4.