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Minimally invasive treatment of complex collections: safety and efficacy of recombinant tissue plasminogen activator as an adjuvant to percutaneous drainage

OBJECTIVE: To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA) injection in the evolution of percutaneous drainage of thick collections. MATERIALS AND METHODS: This was a single-center study involving the retrospective analysis of hospitalized patients undergoing percutaneous...

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Detalles Bibliográficos
Autores principales: Falsarella, Priscila Mina, Rocha, Rafael Dahmer, Rahal Junior, Antonio, Mendes, Guilherme Falleiros, Garcia, Rodrigo Gobbo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124593/
https://www.ncbi.nlm.nih.gov/pubmed/30202126
http://dx.doi.org/10.1590/0100-3984.2017.0086
Descripción
Sumario:OBJECTIVE: To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA) injection in the evolution of percutaneous drainage of thick collections. MATERIALS AND METHODS: This was a single-center study involving the retrospective analysis of hospitalized patients undergoing percutaneous drainage of thick (superficial or intracavitary) fluid collections, followed by injection of a fibrinolytic agent (r-TPA) into the affected space. RESULTS: A total of 53 percutaneous drainage procedures, with r-TPA injection, were performed in 51 patients. Abdominal and pelvic collections were the most common, being seen in 38 (73%) of the procedures; in 35 (66%), the etiology of the collection was attributed to postoperative complications. A total of 61 catheters were used in order to drain the 53 collections. Of those 61 catheters, 52 (85%) were large (12-16 Fr) and 9 (15%) were small (4-10 Fr). The mean r-TPA dose was 5.7 mg/collection per day, and the mean time from r-TPA injection to drain removal was 7.7 days. Percutaneous drainage in combination with r-TPA injection was successful in 96% of the cases. None of the patients showed coagulation changes during the study period. CONCLUSION: The use of once-daily, low-dose r-TPA for up to three consecutive days, as an adjunct to percutaneous drainage of thick collections, with or without loculation, appears to be an effective technique.