A, cryoprecipitate, and activated factor

A, cryoprecipitate, and activated factor PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/12711626 VII, returned his coagulation profile to baseline. Table 4 summarizes the findings of the literature review. The above cases indicate that serious bleeding complications may be more common than they are perceived, and a recent review of intrapleural enzyme therapy called for further documentation of complications and their management [14]. Our case is similar to those discussed above, in that the patient developed massive hemothorax in the setting of therapeutic anticoagulation, however different in that he received combination alteplase with DNase intrapleurally. The contribution of DNase to bleeding is uncertain. This case report adds to the body of data on severe pleural hemorrhage following intrapleural enzyme therapy in patients who are anticoagulated, raising the awareness of this complication among clinicians. In such patients, it is recommended that the risks and benefits of intrapleural therapy versus surgery should be carefully evaluated in a multidisciplinary team environment. Moreover, those who 2-[(4S)-4,5-Dihydro-4-isopropyl-2-oxazolyl]pyridine receive intrapleural enzymes in the setting of bleeding risk factors should be closely monitored. This report is also unique given that hemorrhage continued despite thoracotomy, aggressive correction of coagulopathy, and hemostasis was achieved only after the application of topical fibrin-thrombin sealant, Tisseel. Fibrin-thrombin sealants were first used during hemostasis by Bergal in 1909 [15]. Modern fibrinthrombin sealants, which consist of human origin fibrinogen and thrombin, and antifibrinolytic, aprotinin, have been approved by the FDA for hemostasis, adhesion and sealing. In thoracic surgery, they have been successfully employed to treat persistent bronchopleural fistulas following lung resection or recurrent pneumothorax [16]. Although not a new method of hemostasis per se, this is the first case report to describe the use of fibrin-thrombin sealant to successfully treat refractory pleural hemorrhage following intrapleural fibrinolytic enzyme therapy and anticoagulation. For junior surgeons, including trainees, who have not yet come across severe refractory pleural hemorrhage in practice, webelieve this case report to offer valuable reference of the successful oncotarget.13387 use of topical fibrin-sealant Tert-butyl 2-(chloromethyl)pyrrolidine-1-carboxylate in this context.Conclusions Severe pleural bleeding may complicate the use of intrapleural enzyme therapy for complicated parapneumonic effusion or empyema, particularly in anticoagulated or coagulopathic patients. PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/9544797 In severe refractory pleural hemorrhage, the use of topical fibrin-thrombin sealant can be an effective life-saving adjunct to surgery. Consent Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.Abbreviations APTT: Activated partial thromboplastin time; CRP: C-reactive protein; CT: Computed tomography; DNase: Deoxyribonuclease; HIV: human immunodeficiency virus; ICU: Intensive care unit; INR: International normalized ratio; RCT: Randomized controlled trial; tPA: Tissue plasminogen activator. Competing interests The authors declare that they have no competing interests. Authors' contributions SV initiated the case report, drafted and prepared the manuscript. DL critically reviewed the manuscript. All authors read and approved the final manuscript. Received: 8 September 2015 Accepted: 24 NovemberReferences 1. Lisboa T, Waterer.