Table 5.
Published English-language articles on pericardial fibrinolysis for purulent pericarditis: protocols and outcome
| Reference | Age (years) | TF | Agent | Dose | Volume | Modality | Associated TT tube size | n | Complications | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
| [12] | ND | ND | SK | ND | ND | ND | Tube drain | 1 | ND | Survived; follow-up ND |
| [14] | 35 | P | SK | ND | ND | Daily injection for 12 days | Intrapericardial ATB | |||
| SD | 15 F tube drain | 1 | None | No clinical sign of constriction at 15 months | ||||||
| [15] | 6 | R | SK | 100,000 U | ND | Daily instillations iterative punctures for 7 days | Intrapericardial ATB | 1 | Febrile reactions | No clinical sign of constriction |
| SD | 25,000 U | No drain | Follow-up ND | |||||||
| [17] | 26 | R | SK | 90,000 U | 30 ml | Daily for 1 month | Intrapericardial ATB | 1 | None | No clinical sign of constriction several months later |
| SD | 24,000 U | Sternectomy pericardiostomy | ||||||||
| [13] | ND | ND | SK | ND | ND | ND | Tube drain | 2 | None | Complete evacuation. Constriction sign ND; follow-up |
| ND | ||||||||||
| [16] | 21 to 54 | R | UK | 400,000 U | 20 ml | Each 8 hours | Catheter size ND | 3 | None | One death not related to PP; one without constriction |
| (2 to 7 doses) | on TTE at 1 year; one recovered, no follow-up | |||||||||
| [36] | 76 | R | SK | 100,000 U | 20 ml | Each 8 hours; clamp 1 hour; 1 week | 7F catheter | 1 | None | Survived at 4 months |
| SD | 25,000 U | Intrapericardial ATB | No clinical sign of constriction | |||||||
| [37] | 16 to 38 | R | SK | 250,000 U | ND | Four times; each 2 days | Drainage ND | 2 | None | No clinical sign of constriction at 6 months and 2 years |
| [38] | 78 | R | SK | 250,000 U | 20 to 40 ml | Three times; each 12 hours; clamp | Drainage ND | 1 | Slight bleeding | No clinical or TEE sign of constriction at day 30 |
| [39] | <1 to 12 | R | SK | 10,000 to 15,000 U/kg | ND | Each 12 hours; for 2 to 8 days | 8F catheter | 6 | One bleeding with tamponade | All survived; no clinical or TTE sign of constriction at 19.8 months |
| [40] | 61 | R | SK | 100,000 U | 10 ml | Each 8 hours; for 24 hours; clamp 1 hour | 7F catheter | 1 | None | Persisting PP; need for surgery for pericardial window |
| [41] | 39 | R | UK | 400,000 U | 20 ml | Each 8 hours; for 4 days | Systemic CT, catheter size ND | 1 | None | No clinical sign of constriction at 8 months |
| [28] | 5 to 50 | P | SK | 2,000 U/kg | 50 ml | Daily; for 1 to 6 days | 7F catheter | 6 | None | One death by septic shock; five with no clinical sign of constriction; follow-up ND |
| [42] | 36 | R | SK | 300,000 U | ND | Daily; for 5 days | Catheter size ND | 1 | None | Failure: tamponade at 3 weeks; partial pericardiectomy. No sign of constriction at 2 months |
| [43] | <1 to 4 | P | SK | ND | ND | Daily; duration ND | Catheter size ND | 3 | One nonsevere bleeding | Complete evacuation. No TTE sign of constriction at 3 years |
| [44] | 61 | R | tPA | 30 mg | 100 ml | ND | Surgical drainage | 1 | None | Survived; no TTE sign of constriction |
| [45] | 41 | R | UK | 120,000 U | 10 ml | Daily; clamp 12 hours; for 5 days | 16F catheter | 1 | None | No constriction on TTE at discharge.; follow-up: 3 years |
| [46] | 50 | R | SK | 500,000 U | 50 ml | Three instillations in 10 minutes the first day | 7F catheter | 1 | None | No constriction on TTE at 12 weeks |
| [47] | 3 to 13 | P | SK | 15,000 U/kg | 50 ml | Solution warmed; clamp 2 hours | 7F catheter | 6 | None | All patients followed up 6 months to 5 years; no clinical sign of constriction |
| [3] | 9 to 66 | P | UK | 200,000 U | 20 ml | Clamp 1 hour | 7F catheter | 94 | 12.7% nonsevere bleeding | TTE signs of constriction: 19% in UK group vs. 57% in controla |
| [48] | <1 | R | tPA | ND | ND | Three instillations; each 12 hours; clamp 2 hours | Catheter ND | 1 | None | No TTE sign of constriction at hospital at discharge; follow-up ND |
ATB, antibiotic; CT, computed tomography; n, number of patients; ND, not determined in the article; P, primary fibrinolysis; PP, purulent pericarditis; R, fibrinolysis in rescue; SD, streptodornase; SK, streptokinase; TEE, transesophageal echocardiography; TF, timing of fibrinolysis; tPA, tissue plasminogen activator; TT, treatment; TTE, transthoracic echocardiography; U, units; UK, urokinase. aHeterogeneous population with tuberculous and purulent pericarditis.