Analysing Outcome of Intra Pleural Instillation of Streptokinase in Loculated Effusion - Prospective Study

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Dr. Aiswarya Mathiyalagan
Dr Swetha Sasikumar
Dr. Prasanth Gururaj
Dr. Anbumaran Parivakkam Mani
Dr Gangadharan Vadivelu


The present prospective study was conducted to evaluate the efficacy and safety of intra-pleural instillation of streptokinase in loculated pleural effusion patients. Loculated pleural effusion, which refers to the presence of fluid within the pleural space encapsulated by fibrin barriers, is a challenging situation making the drainage and resolution of the fluid difficult. Streptokinase, a fibrinolytic agent, can act as a potential aid to help dissolve these loculations, aiding in fluid drainage and further re-expansion of the collapsed lung. The study was conducted by enrolling patients with loculated pleural effusion confirmed through imaging studies. Intra-pleural instillation of streptokinase was administered under ultrasound or fluoroscopic guidance. The primary outcome parameters depended upon the dissolution of loculations, lung re-expansion, pleural fluid volume reduction, and adverse events. A preliminary analysis of the data shows that the results obtained were promising. A large proportion of patients had loculations dissolved and the lung expanded significantly following instillation of streptokinase in the pleural space. The pleural fluid volume is also noted to be significantly reduced. This finding indicates the efficacy of streptokinase in dissolving the loculations and facilitating loculated pleural effusion drainage. Moreover, the procedure had an acceptable safety profile, with few serious adverse events reported. The most common adverse events noted were mild and self-limiting, including minor local irritation due to instillation. Prerequisites for an optimal streptokinase regime for loculated pleural effusion include larger evidence bases and longer follow-up provisions. However, no severe reports of adverse events involving streptokinase complications were noted in any of the cases studied during the study period.

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