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. 2025 Aug;30(4):484-493.
doi: 10.5863/JPPT-24-00057. Epub 2025 Aug 11.

Use of Intrapleural Alteplase in the Treatment of Parapneumonic Effusion in Children: A Report of a 10-year Experience

Yusuf M Garwan  1   2 , Muath A Alsalloum  1   2 , A Jill Thompson  1   3 , Taylor Morrisette  1   3 , Katherine H Chessman  1   3
Affiliations

Use of Intrapleural Alteplase in the Treatment of Parapneumonic Effusion in Children: A Report of a 10-year Experience

Yusuf M Garwan et al. J Pediatr Pharmacol Ther. 2025 Aug.

Abstract

Objectives: Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.

Methods: A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.

Results: Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.

Conclusions: Lower alteplase doses (≤2 mg) were effective for most children with PPE. Alteplase combined with primary VATS might be associated with better outcomes.

Keywords: VATS; alteplase; chest tube; children; empyema; parapneumonic effusion.

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Figures

Figure 1.
Figure 1.
Alteplase dose per weight and age.
Figure 2.
Figure 2.
Median chest tube output 24 hours before and after the first alteplase dose by treatment group.
See this image and copyright information in PMC

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