LAUSR

Frank Schembri The Pulmonary Center Boston University School of Medicine Boston, MA 02118 J Scott Ferguson Division of Pulmonary and Critical Care University of Wisconsin School of Medicine and Public Health Madison, WI 53705 The use of intrapleural thrombolytics as an adjunct therapy to promote pleural drainage is probably best elucidated in patients with pleural infections 1 , but has also been studied for other indications including traumatic or nontraumatic retained hemothorax 2 and multiloculated malignant pleural effusions(MPE). Considering that malignant pleural effusions have increased pro-coagulant properties and depressed fibrinolytic activity similar to other causes of exudative pleuritis 3 , it is not surprising that over time many MPEs form fibrinous strands and multiple loculations. This presumably leads to difficulty with management since fibrinous material may preclude adequate drainage and lung expansion before pleurodeisis or impede tunneled pleural catheter function. A natural clinical question then is “can improved drainage with the use of fibrinolytics improve dyspnea and pleurodesis in the management of MPE?”