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Table 4 Summary of results of literature review

From: Life-threatening pleural hemorrhage following intrapleural enzyme therapy and successful treatment with fibrin-thrombin sealant pleurodesis: a case report

Study

Study type

Sample

Intrapleural therapy used

Anticoagulation or antiplatelet use

Hemorrhagic complications

Thommi et al. 2012 [11]

Single centre placebo controlled randomized controlled trial

68 adults

Placebo or alteplase

Unspecified

Hemorrhage requiring transfusion in two patients

Rahman et al. 2011 [5]

Multicentre placebo controlled randomized trial

210 adults

Placebo or alteplase or DNase or alteplase + DNase

Unspecified

Two intrapleural hemorrhages and one hemoptysis in alteplase + DNase group. Two episodes of gastrointestinal bleeding in the DNase group.

Maskell et al. 2005 [4]

Multi-centre placebo controlled randomized trial

427 adults

Placebo or streptokinase

Unspecified

Seven hemorrhages (local or systemic) in streptokinase group, six in placebo group

Nie et al. 2014 [10]

Meta-analysis of randomized trials

879 adults, 98 children

Placebo, streptokinase, urokinase, tPA

Unspecified

Nonsignificant increase in severe side effects

Piccolo et al. 2014 [13]

Retrospective observational study

107 adults

tPA and DNase

Unfractionated heparin × 1, chronic liver disease and ↑prothrombin time × 1

Hemorrhage requiring transfusion in two patients

Anevlavis et al. 2011 [7]

Case series

Two adults

Alteplase

Therapeutic dose tinzaparin (14,000 IU), Prophylactic tinzaparin (3500 IU)

Two massive pleural hemorrhages

Chai and Kuan, 2011 [17]

Case report

One adult

Streptokinase

Nil

Massive pleural hemorrhage

Goralski et al. 2009 [9]

Case report and literature review

One adult

Alteplase

Nil

Severe pleural hemorrhage

Gervais et al. 2008 [12]

Retrospective observational study

66 adults

Alteplase

Warfarin × 1, low-molecular-weight heparin (dalteparin 5000U TDS) × 2, unfractionated heparin × 1

Five major pleural hemorrhages in four patients who were anticoagulated. No hemorrhage in those receiving prophylactic anticoagulation or clopidogrel

Ruiz et al. 2006 [8]

Case report

One adult

Alteplase

Nil

Massive pleural hemorrhage

  1. DNase deoxyribonuclease, tPA tissue plasminogen activator