The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses: 25 Cases (2007–2012)

Journal of Veterinary Internal Medicine

J.E. Tomlinson⁹  E. Byrne⁵  N. Pusterla¹  K. Gary Magdesian¹  H.G. Hilton³  B. McGorum⁸  E. Davis²  A. Schoster⁴  L. Arroyo⁴  B. Dunkel⁶  H. Carslake⁷  R.C. Boston⁹ 

[1] Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA;Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS;Departments of Structural Biology and Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA;Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada;Alamo Pintado Equine Medical Center, Los Olivos, CA;Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Herts, UK;Philip Leverhulme Equine Hospital, University of Liverpool, Wirral, UK;Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK;Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA

关键词: intrapleural;    fibrinolysis;    alteplase;    pleuritis;   

DOI  :  10.1111/jvim.13594

来源: Wiley

【 摘 要 】

Abstract

Background

Information about treatment protocols, adverse effects and outcomes with intrapleural recombinant tissue plasminogen activator (rTPA) use in horses with fibrinous pleuropneumonia is limited.

Hypothesis/Objectives

Describe factors that contribute to clinical response and survival of horses treated with rTPA intrapleurally.

Animals

Horses with bacterial pneumonia and fibrinous pleural effusion diagnosed by ultrasonography, that were treated with rTPA intrapleurally.

Methods

Retrospective multicenter case series from 2007–2012. Signalment, history, clinical and laboratory evaluation, treatment, and outcome obtained from medical records. Regression analysis used to identify associations between treatments and outcomes.

Results

Thirty three hemithoraces were treated in 25 horses, with 55 separate treatments. Recombinant tissue plasminogen activator (375–20,000 μg/hemithorax) was administered 1–4 times. Sonographically visible reduction in fibrin mat thickness, loculations, fluid depth, or some combination of these was seen in 32/49 (65%) treatments. Response to at least 1 treatment was seen in 17/20 (85%) horses with sonographic follow-up evaluation after every treatment. Earlier onset of rTPA treatment associated with increased survival odds. No association was found between cumulative rTPA dose or number of rTPA doses and survival, development of complications, duration of hospitalization or total charges. Clinical evidence of hypocoagulability or bleeding was not observed. Eighteen horses (72%) survived to discharge.

Conclusions and clinical importance

Treatment with rTPA appeared safe and resulted in variable changes in fibrin quantity and organization within the pleural space. Recombinant tissue plasminogen activator could be a useful adjunct to standard treatment of fibrinous pleuropneumonia, but optimal case selection and dosing regimen remain to be elucidated.

【 授权许可】

CC BY-NC   
Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

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