Fibrinolytic Therapy for Retained Hemothorax

Introduction to Fibrinolytic Agents

Streptokinase is a bacterial-derived protein that is highly antigenic, generating systemic antibody responses, and has significant limitations including fever after intrapleural injection and a higher risk/benefit ratio compared to other fibrinolytics, according to the British Thoracic Society 1, 2
Urokinase is non-antigenic, derived from human urine, with rare hypersensitivity reactions, but is no longer available in North America, as noted by the British Thoracic Society 1, 2

Bleeding complications are rare but have been reported, particularly with traumatic drain insertion, with minor side effects including discomfort during injection and transient blood staining of drainage fluid, as reported in Thorax 1, 2
The BTS/MRC Multicentre Intrapleural Streptokinase Trial showed that streptokinase had no beneficial effect in adult empyema, though this finding was in empyema rather than hemothorax, according to the British Thoracic Society 3, 1, 2