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DOI: https://doi.org/10.4046/trd.2020.0018    [Accepted]
Published online December 17, 2020.
Fibrinolysis with Lower Dose Urokinase in Patients with Complicated Parapneumonic Effusion
Seul Lee, 1, Heock Lee, 1, Dong Hyun Lee, 1,2, Bo Hyoung Kang, 1, Mee Sook Roh, 3, Choohee Son, 1, Sung Hyun Kim, 4, Hyun-Kyung Lee, 4, Soo-Jung Um, 1
1Department of Internal Medicine, Pulmonology Division, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
2Department of Intensive Care Medicine, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
3Department of Pathology, Dong-A University Hospital, College of Medicine, Dong-A University, Busan, Republic of Korea
4Department of Internal Medicine, division of pulmonology, allergy and critical care medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
Correspondence:  Soo-Jung Um, Tel: 82-51-240-2769, 
Email: sjum@dau.ac.kr
Received: 7 August 2020   • Revised: 22 October 2020   • Accepted: 15 December 2020
Abstract
Background
Intrapleural urokinase is one of the most widely used fibrinolytic agent in the treatment of complicated parapneumonic effusion (CPPE). However, there has been little research for the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose.
Methods
We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at 2 tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatment as part of routine care. The primary outcome was the treatment success rate in half dose urokinase group (50,000 IU daily for maximal 6 days) and conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within 1 month.
Results
Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose. Both groups were relatively well matched at baseline excluding higher serum white blood cell count and higher empyema prevalence in the half dose group. The treatment success rate was not different between two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and catheter indwelling duration. In the multivariate analysis, urokinase dose was not a predictor for treatment success.
Conclusion
Half dose intrapleural urokinase is equally as effective as conventional dose to treat patients with CPPE or empyema.
Key Words: catheters, empyema, fibrinolysis, indwelling, pleurisy, pneumonia


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