Introduction: Intrapleural instillation of fibrinolytics has been well established in the management of complicated parapneumonic effusion and empyema.

Aim: To present our experience on the intrapleural instillation of fibrinolytics and outcomes of patients with complicated parapneumonic effusion/empyema.

Methods: Hospitalized patients with complicated parapneumonic effusion/empyema who were treated with intrapleural instillation of r-tPA between 01/01/2021 and 30/09/2022 were included in the study.

Results: Thirty-one patients (n=31) were analyzed [male: 90%, mean age ± SD =60.4 ± 12.3, smokers/never smokers: 24/7, median value of hospitalization days: 12 (95% CI: 11.0 to 16.4)]. Comorbidities or immunosuppression were recorded in 71.0% (n=22) and in 51.1% (n=16) of patients, respectively. Neutrophilic pleural effusions and causative microbial agent were recorded in 87.1% (n=27) and 80.6% of cases (n=25), respectively. Median values of pleural fluid glucose and LDH were 29 mg/dL (95% CI: 3 to 45) and 1176 U/L (95% CI: 851 to 3646), respectively. Positive cytology for malignancy was recorded in 2 patients. Intrapleural fibrinolytics showed an excellent safety and effectiveness profile with no major side-effects and need for surgery in 97% of cases (n=30). One patient (3%) died due to malignant pleural mesothelioma.

Conclusion: Intrapleural instillation of r-tPA in complicated parapneumonic effusion or empyema constitutes a safe and effective treatment modality.