Narayanan Subramanian - Army College of Medical Sciences and Base Hospital, New Delhi, India
Debajyoti Bhattacharyya - Army Hospital Research and Referral, New Delhi, India
Inam Danish Khan - Army College of Medical Sciences and Base Hospital, New Delhi, India
Vishnu Prasad - Army College of Medical Sciences and Base Hospital, New Delhi, India
Arun Kotaru - Venkateshwara Hospital, Dwarka, New Delhi, India
Vasu Vardhan - Armed Forces Medical College, Pune, India
Kapil Pandya - Army College of Medical Sciences and Base Hospital, New Delhi, India

Background: Tuberculous, parapneumonic and traumatic loculated pleural-effusions pose therapeutic challenges due to resultant pleural-thickening and compromised lung-function for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleural-effusion to reduce the burden and sequelae. Objective: An uncontrolled and blind before-after intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiary-care respiratory center after obtaining approval and written informed consent. Methods: Fifty-one patients with loculated pleural effusion were administered with repeated cycles of three doses of ۱ Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre- and post-IPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The Kolmogorov-Smirnov test and paired t test with significance at a P value less than ۰.۰۵ were applied to test statistically significant differences in proportions and means, respectively. Results: Tuberculosis was the most common etiology leading to loculated pleural effusion (۸۰%), and ۸۲.۴% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in ۸۰.۴% of patients. Chest pain (۱۳.۷%) and fever (۹.۸%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre- and post-IPFT from ۱۸۴±۸۱ ml to ۶۷±۵۲ ml was observed. Conclusion: IPFT with urokinase is an effective treatment modality in patients with post-tubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function.

Tuberculosis, Intrapleural Fibrinolytic Therapy, Pleural Effusion, Urokinase