Why the study?
Literature regarding recombinant tissue plasminogen activator therapy for purulent pericarditis is scant and largely limited to case reports or case series.
Does intrapericardial alteplase improve clinical recovery and prevent constrictive pericarditis in patients with purulent pericarditis?
Does intrapericardial alteplase improve clinical recovery and prevent constrictive pericarditis in patients with purulent pericarditis?
Intrapericardial fibrinolysis with alteplase may be a safe and effective less-invasive alternative to pericardiectomy for purulent pericarditis with loculated effusions.
May support adjunctive intrapericardial r-tPA in purulent pericarditis; leaves open efficacy versus drainage alone in controlled trials.
Purulent pericarditis is the infection of the pericardial space with pus formation. High mortality and morbidity can be explained by cardiac tamponade and septic shock in the acute phase, while chronically, it can lead to recurrent purulent pericarditis and constrictive pericarditis. We present two cases of purulent pericarditis treated with intrapericardial recombinant tissue plasminogen activator (r-tPA) for three consecutive days in addition to surgical pericardial drainage. In both instances, loculated effusions and re-accumulation of pericardial fluid persisted despite adequate antibiotic coverage and surgical drainage. Intrapericardial fibrinolysis was considered a less invasive alternative to extensive surgery to prevent constrictive pericarditis and improve clinical outcomes. Both patients had complete clinical recovery and there was no evidence of constrictive pericarditis during follow-up. There is scant literature regarding r-tPA therapy for purulent pericarditis, most of which is limited to case reports or case series. The most commonly used regimen is three doses of tPA administered into the pericardial space over three days. It is a safe and potentially effective therapy in preventing constrictive pericarditis and need of pericardiectomy.
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Poudyal et al. (2023) studied this question.
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