Table 1.

Patients receiving alteplase-dornase via the intra-abdominal route.

Drain indication	Indication for therapy	Drain size	Dose administered	Number of doses	Administered concurrently or sequentially	Anticoagulants and/or antiplatelets held (yes/no)	Complications (yes/no)	Results (discharge, death, surgical procedure, etc.)
Pancreatic and psoas walled-off pancreatic necrosis/abscess, VARD preparation	Low-output abdominal drain	14 Fr	10 mg alteplase 5 mg dornase	7 doses	Sequential	No (prophylaxis)	No	Mild decrease in fluid collection, eventual VARD and discharge on antibiotics
Pancreatic abscess after necrotizing pancreatitis and cholecystectomy	Low-output abdominal drain	2 drains of unknown size placed	10 mg alteplase and 5 mg dornase, both in 30-mL volume	7 doses	Sequential	No—patient on therapeutic heparin infusion for DVT	Yes—dark, bloody output from drains Blood pressure dropped to 87/49 Patient received PRBCs, heparin held, active bleed from splenic artery embolized by IR	Increase in drain output, 2 weeks later patient required large-volume abdominal hematoma evacuation
Hepatic abscess	Low-output abdominal drain	14 Fr or 10 Fr, unclear which	10 mg alteplase and 5 mg dornase, in only 10-mL volume for both	2 doses	Concurrent	Yes (prophylaxis)	No, but received blood products/vitamin K concurrently due to liver synthetic dysfunction	Increase in drain output, discharged on antibiotics
Abdominal fluid collection	Possibly clotted abdominal drain	14 Fr	10 mg alteplase and 5 mg dornase, only 10-mL volume for both	1 dose	Concurrent	Yes	No	Discharged
Right lower quadrant abscess	Low-output abdominal drain	12 Fr	10 mg alteplase and 5 mg dornase	2 doses	Concurrent	No	No	Increase in drain output, discharged on antibiotics
Peritonitis caused by sigmoid perforation	Inability to flush left distal drain	3 drains of unknown size	10 mg alteplase and 5 mg dornase	First course 8 doses, second course 6 doses, third course 5 doses, 3 courses of 6 doses of dornase	Concurrent	No	No	Decrease in fluid collection volume, discharged to rehab on antibiotics
Nondraining abdominal drain	Left hemiabdomenal collection	14 Fr	10 mg alteplase and 5 mg dornase	3 doses each	Concurrent	Yes—due to prior bleed and previous therapeutic anticoagulation	Yes. Bleeding from abdomen-requiring PRBCs	Discharged to SAR
Surgical-site infection	Reduced JP drain output	14 Fr	10 mg alteplase and 5 mg dornase	2 doses each	Concurrent	No	No	Therapy stopped due to drain migration into pleural space
Infected pancreatic pseudocyst	Reduced JP drain output that became thick with debris	14 Fr	10 mg alteplase and 5 mg dornase	6 doses each	Concurrent	Yes	No	Stable fluid collection, drain with output, discharged on antibiotics
Necrotizing pancreatitis	New Blake drain placed—prophylaxis	Unknown	10 mg alteplase and 5 mg dos	2 doses each	Concurrent	No	No	VARD for necrotizing pancreatitis, discharged
For biliary leak and to possibly reduce amount of external drainage	Nondraining abdominal drains	14 Fr (×2)	1 mg alteplase, 10 mg alteplase, and 5 mg dornase	1 dose of alteplase, 1 mg in each drain; 12 doses of alteplase, 10 mg (total between 2 drains); 10 mg dornase, 9 doses of dornase (total between 2 drains)	Sequential	No	No (just complained of abdominal pain)	Drain exchange 4 days after last doses given, back to OR 3 days after drain exchange for abdominal wound debridement, drainage of abscess, and drain placement
Rectus sheath hematoma	To help with hematoma evacuation	14 Fr	10 mg alteplase and 5 mg dornase	5 doses of alteplase, 6 doses of dornase	Sequential	No—continued heparin infusion and warfarin	No	Good drainage, discharged
Infected loculated hemoperitoneum	Nondraining abdominal drain	14 Fr	10 mg alteplase and 5 mg dornase	5 doses	Concurrent	N/A, not on AC	No	Blood draining in JP appropriately, discharged

Fr, French; VARD, video-assisted retroperitoneal debridement; DVT, deep vein thrombosis; PRBCs, packed red blood cells; IR, interventional radiology; SAR, subacute rehabilitation; JP, Jackson-Pratt; OR, operating room; N/A, not applicable; AC, anticoagulation