EFFECTIVENESS OF FIBRINOLYTIC THERAPY IN TRAUMATIC HEMOTHORAX: A RANDOMIZED TRIAL OF INTRAPLEURAL STREPTOKINASE yadvendradheer@kgmcindia.edu

 

EFFECTIVENESS OF FIBRINOLYTIC THERAPY IN TRAUMATIC HEMOTHORAX: A RANDOMIZED TRIAL OF INTRAPLEURAL STREPTOKINASE

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India

Oral or Poster

Thoracic trauma contributes significantly to morbidity and mortality, accounting for 25% of trauma-related deaths. Retained hemothorax, defined as residual blood in the pleural cavity 24–72 hours after chest drain insertion, can lead to complications like empyema and fibrothorax. While VATS is a standard approach, intrapleural fibrinolytic therapy offers a less invasive alternative. This study aimed to evaluate the efficacy of intrapleural streptokinase (STK) in managing retained hemothorax.

This randomized controlled trial was conducted in the Department of Trauma Surgery, KGMU, from April 2024 to April 2025. Patients with isolated chest trauma and retained hemothorax were divided into two groups. The case group received intrapleural STK (250,000 units in 100 mL saline) on days 2, 3, and 4 after 48 hours of non-draining intercostal chest drain (ICD), with clamping for three hours post-instillation. The control group received standard care. Data included clinical history, radiological findings, hospital stay, ICD duration, complications, and need for surgery.

The STK group showed significantly shorter resolution time (3.59 vs. 5.96 days, p<0.05) and ICD duration. However, their hospital stay was longer (14.63 vs. 8.27 days, p=0.000) due to delayed presentation. Surgical intervention was required in only 7.84% of STK cases, and fewer pulmonary complications were observed.

Intrapleural STK proved to be a safe and effective modality, reducing the need for surgical intervention. It should be considered in selected trauma patients, particularly in late-presenting, clotted hemothorax.