Timing of Intrapleural Streptokinase administration for Managing Post traumatic Clotted Hemothorax

Ahmed M Abdelazim; Mahmoud M Abdel Azeem Mubarak

Ahmed M Abdelazim Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mahmoud M Abdel Azeem Mubarak Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Clotted hemothorax, Chest trauma, Fibrinolytic therapy, Streptokinase

Abstract

Background: The optimal timing of intrapleural fibrinolytic therapy with streptokinase for managing posttraumatic clotted hemothorax is controversial. This study investigated the appropriate timing for fibrinolytic therapy initiation using streptokinase in post traumatic clotted hemothorax.

Methods: We conducted a randomized clinical study that included 60 patients with a clotted hemothorax recruited between December 2023 to July 2024. Patients were grouped according to the timing of intrapleural streptokinase injection into two groups. Group I (n= 30) included patients who received intrapleural streptokinase between day 3 and day 7, and Group II (n= 30) included patients who received streptokinase 7 days after the diagnosis of clotted hemothorax.

Results: There were no significant differences in age, sex, the prevalence of diabetes mellitus, hypertension, addiction, or smoking between the groups. The most common mode of trauma was stabbing wounds, with no difference in trauma mode or laterality between the groups. The number of streptokinase doses was significantly lower in patients who had streptokinase early (p<0.001), and their total drainage after administration was significantly greater than that in those who had streptokinase late (275 (200–400) vs. 100 (100–150) ml, p<0.001). The infection rate was higher in patients with late streptokinase administration (1 (3.33%) vs. 8 (26.67%), p= 0.026). No bleeding was reported in either group. The length of hospital stay was significantly longer in patients with late streptokinase administration (8 (7--9) vs. 19 (17--20), p<0.001). The success rate was 90% in the early group and 53% in the late group (p= 0.004). One patient in the early group and 23 (77%) in the late group required further surgical evacuation (p<0.001).

Conclusion: Early intrapleural administration of streptokinase (within 3–7 days of clotted hemothorax) appears to be more effective than late administration (after 7 days) for managing posttraumatic clotted hemothorax.