• Bleeding risk with combination intrapleural fibrinolytic and enzyme therapy in pleural infection - an international, multicenter, retrospective cohort study.

      Akulian, Jason; Bedawi, Eihab O; Abbas, Hawazin; Argento, Christine; Arnold, David T; Balwan, Akshu; Batra, Hitesh; Uribe Becerra, Juan Pablo; Belanger, Adam; Berger, Kristen; et al. (Elsevier, 2022-06-15)
      Overall pleural bleeding incidence was 76/1833=4.1% (95%CI 3.0% to 5.0%). Using a half-dose regimen (tPA 5mg) did not significantly change this risk (6/172=3.5%; p=0.68). Therapeutic anticoagulation (AC) alongside IET was associated with increased bleeding rates (19/197=9.6%) compared to temporarily withholding AC prior to administration of IET (3/118=2.6%, p=0.017). As well as systemic AC, increasing RAPID score, an elevated serum urea and platelets <100x109 L were associated with a significant increase in bleeding risk. However, only RAPID score and use of systemic AC were independently predictive. Apart from pain, non-bleed complications were rare.