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Eur J Cardiothorac Surg 2005;27:667-670
© 2005 Elsevier Science NL

Use of intrapleural streptokinase in experimental minimal clotted hemothorax

Ayten Kay Cangr^a,*, Cabir Yüksel^a, Mehmet Dakak^b, Enver Özgencil^c, Onur Genc^b, Hadi Akay^a

^a Department of Thoracic Surgery, Ankara University Medical School, bn-i Sina Hastanesi, Samanpazari-Sihhiye, 06100 Ankara, Turkey
^b Department of Thoracic Surgery, Gülhane Military Medical Academy, Ankara, Turkey
^c Department of Anesthesiology and Reanimation, Ankara University Medical School, Ankara, Turkey

Received 18 October 2004; received in revised form 20 December 2004; accepted 21 December 2004.

^* Corresponding author. Address: Ankara Üniversitesi Tp Fakültesi, bn-i Sina Hastanesi, Göüs Cerrahisi Anabilim Dal, Sihhiye, Ankara 06100, Turkey. Tel.: +90 312 310 3333x2607/241 2011; fax: +90 312 310 6371. (E-mail: cangir{at}medicine.ankara.edu.tr).

Objective: In clotted hemothorax, both thoracocentesis and closed tube thoracostomy will not be able to evacuate the pleural cavity especially if it is minimal. The aim of this study was to assess the effectiveness of intrapleural administered streptokinase on minimal clotted hemothorax without drainage, in order to accelerate the spontaneous resolution and absorption in blunt thoracic trauma. Methods: Thirteen adult ewes were used for this experiment. The animals were divided into two groups. First group served as the control group (Group C) (n=5) and did not receive any intrapleural fibrinolytic treatment. In both groups, 200ml of blood was taken from the left jugular vein and injected into the pleural cavity with a serum line through the scope after pleural abrasion. Streptokinase (150.000U) was diluted in 100ml of saline and applied to the second group (Group S) (n=5) in second postoperative day. One ewe in each group was sacrificed with a lethal dose of sodium thiopental in postoperative 2nd, 4th, 6th, 8th, and 10th weeks, respectively. When a left posterolateral thoracotomy was performed, pleural thickening and adhesion were evaluated. The lung and pleural tissue samples were taken for histopathologic examination. The slides were examined in a blinded manner. Results: Thoracentesis was performed in all ewes in the second postoperative day and no fluid was detected. There was no allergic reaction in group S after the injection of streptokinase into the pleural cavity. During postmortem macroscopic evaluation, we observed clot in one of the ewes in group C in second postoperative week. A statistically significant difference was found between Group C and S regarding pleural thickening and adhesion (P=0.05). The ewes of Group S had less pleural thickening and adhesion compared to those of Group C. These results were confirmed with histopathological examination. Conclusion: We conclude that intrapleural streptokinase increases resolution of clot in the pleural space and decreases pleural thickening and adhesion in experimental minimal clotted hemothorax in ewes. This study has also demonstrated that intrapleural streptokinase can be used without drainage. Use of intrapleural streptokinase without drainage can be a novel therapeutic option for trauma patients with minimal clotted hemothorax after haemorrhage of other organs was excluded.

Key Words: Clotted hemothorax • Fibrinolytic treatment • Streptokinase