Clinical review: Intrapericardial fibrinolysis in management of purulent pericarditis

Augustin, Pascal; Desmard, Mathieu; Mordant, Pierre; Lasocki, Sigismond; Maury, Jean-Michel; Heming, Nicholas; Montravers, Philippe

doi:10.1186/cc10022

Table 5 Published English-language articles on pericardial fibrinolysis for purulent pericarditis: protocols and outcome

From: Clinical review: Intrapericardial fibrinolysis in management of purulent pericarditis

Reference	Age (years)	TF	Agent	Dose	Volume	Modality	Associated TT tube size	n	Complications	Outcome
[12]	ND	ND	SK	ND	ND	ND	Tube drain	1	ND	Survived; follow-up ND
[14]	35	P	SK	ND	ND	Daily injection for 12 days	Intrapericardial ATB
			SD				15 F tube drain	1	None	No clinical sign of constriction at 15 months
[15]	6	R	SK	100,000 U	ND	Daily instillations iterative punctures for 7 days	Intrapericardial ATB	1	Febrile reactions	No clinical sign of constriction
			SD	25,000 U			No drain			Follow-up ND
[17]	26	R	SK	90,000 U	30 ml	Daily for 1 month	Intrapericardial ATB	1	None	No clinical sign of constriction several months later
			SD	24,000 U			Sternectomy pericardiostomy
[13]	ND	ND	SK	ND	ND	ND	Tube drain	2	None	Complete evacuation. Constriction sign ND; follow-up
										ND
[16]	21 to 54	R	UK	400,000 U	20 ml	Each 8 hours	Catheter size ND	3	None	One death not related to PP; one without constriction
						(2 to 7 doses)				on TTE at 1 year; one recovered, no follow-up
[36]	76	R	SK	100,000 U	20 ml	Each 8 hours; clamp 1 hour; 1 week	7F catheter	1	None	Survived at 4 months
			SD	25,000 U			Intrapericardial ATB			No clinical sign of constriction
[37]	16 to 38	R	SK	250,000 U	ND	Four times; each 2 days	Drainage ND	2	None	No clinical sign of constriction at 6 months and 2 years
[38]	78	R	SK	250,000 U	20 to 40 ml	Three times; each 12 hours; clamp	Drainage ND	1	Slight bleeding	No clinical or TEE sign of constriction at day 30
[39]	<1 to 12	R	SK	10,000 to 15,000 U/kg	ND	Each 12 hours; for 2 to 8 days	8F catheter	6	One bleeding with tamponade	All survived; no clinical or TTE sign of constriction at 19.8 months
[40]	61	R	SK	100,000 U	10 ml	Each 8 hours; for 24 hours; clamp 1 hour	7F catheter	1	None	Persisting PP; need for surgery for pericardial window
[41]	39	R	UK	400,000 U	20 ml	Each 8 hours; for 4 days	Systemic CT, catheter size ND	1	None	No clinical sign of constriction at 8 months
[28]	5 to 50	P	SK	2,000 U/kg	50 ml	Daily; for 1 to 6 days	7F catheter	6	None	One death by septic shock; five with no clinical sign of constriction; follow-up ND
[42]	36	R	SK	300,000 U	ND	Daily; for 5 days	Catheter size ND	1	None	Failure: tamponade at 3 weeks; partial pericardiectomy. No sign of constriction at 2 months
[43]	<1 to 4	P	SK	ND	ND	Daily; duration ND	Catheter size ND	3	One nonsevere bleeding	Complete evacuation. No TTE sign of constriction at 3 years
[44]	61	R	tPA	30 mg	100 ml	ND	Surgical drainage	1	None	Survived; no TTE sign of constriction
[45]	41	R	UK	120,000 U	10 ml	Daily; clamp 12 hours; for 5 days	16F catheter	1	None	No constriction on TTE at discharge.; follow-up: 3 years
[46]	50	R	SK	500,000 U	50 ml	Three instillations in 10 minutes the first day	7F catheter	1	None	No constriction on TTE at 12 weeks
[47]	3 to 13	P	SK	15,000 U/kg	50 ml	Solution warmed; clamp 2 hours	7F catheter	6	None	All patients followed up 6 months to 5 years; no clinical sign of constriction
[3]	9 to 66	P	UK	200,000 U	20 ml	Clamp 1 hour	7F catheter	94	12.7% nonsevere bleeding	TTE signs of constriction: 19% in UK group vs. 57% in control^a
[48]	<1	R	tPA	ND	ND	Three instillations; each 12 hours; clamp 2 hours	Catheter ND	1	None	No TTE sign of constriction at hospital at discharge; follow-up ND

ATB, antibiotic; CT, computed tomography; n, number of patients; ND, not determined in the article; P, primary fibrinolysis; PP, purulent pericarditis; R, fibrinolysis in rescue; SD, streptodornase; SK, streptokinase; TEE, transesophageal echocardiography; TF, timing of fibrinolysis; tPA, tissue plasminogen activator; TT, treatment; TTE, transthoracic echocardiography; U, units; UK, urokinase. ^aHeterogeneous population with tuberculous and purulent pericarditis.

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