The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses: 25 Cases (2007-2012).
Abstract: Information about treatment protocols, adverse effects and outcomes with intrapleural recombinant tissue plasminogen activator (rTPA) use in horses with fibrinous pleuropneumonia is limited. Objective: Describe factors that contribute to clinical response and survival of horses treated with rTPA intrapleurally. Methods: 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: 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.
Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Publication Date: 2015-08-07 PubMed ID: 26256909PubMed Central: PMC4858032DOI: 10.1111/jvim.13594Google Scholar: Lookup
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- Journal Article
- Multicenter Study
Summary
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This research conducted retrospective multicentre case studies on 25 horses that had been diagnosed with fibrinous pleuropneumonia and were treated with an intrapleural drug called recombinant tissue plasminogen activator (rTPA) between the years 2007 to 2012. The study established that a treatment protocol involving rTPA demonstrated changes in fibrin quantity and structure within the pleural space. Such treatment was safe and could be pivotal as an add-on to the standard treatment of fibrinous pleuropneumonia in horses.
Methods
- The horses selected for the study were diagnosed with bacterial pneumonia and fibrinous pleural effusion through ultrasonography.
- They were treated with rTPA, a drug administered intrapleurally (into the pleural cavity).
- The research was retrospective and multicenter, meaning that the researchers collected data about the horses and their treatments from veterinary records, dating from 2007 to 2012.
- Regression analysis, a statistical method, was used to identify potential associations between treatments and outcomes.
Results
- A total of 33 hemithoraces (half of the thoracic cavity) in 25 horses were given rTPA treatment in 55 separate procedures.
- The quantity of rTPA administered varied between 375 to 20,000 μg per hemithorax, and each horse underwent 1-4 doses.
- An ultrasound visible reduction in fibrin mat thickness, loculations, fluid depth, or a combination of these was observed in 65% of the treatments.
- 85% of the horses displayed response to at least one rTPA treatment as affirmed by ultrasound follow-up evaluation post treatment.
- The study found that initiating the rTPA treatment earlier increased survival likelihood in horses.
- There was no evident statistical relationship between the cumulative rTPA dose or number of doses per horse and the survival rate, development of complications, duration of admission, or total hospitalization costs.
- Signs of hypocoagulability (slow blood clotting) or abnormal bleeding were not observed in the horses during the treatment.
- Of the horses treated, 72% survived and were discharged from the hospital.
Conclusions
- rTPA treatment showed efficacy in altering fibrin quantities and patterns within the pleural space of the horses.
- The administration of rTPA was deemed safe, with no evidence of adverse effects such as unusual bleeding or slow blood clotting.
- This indicates that rTPA could be a beneficial addition to existing standard treatment for fibrinous pleuropneumonia in horses, though the ideal case selection criteria and dosing regimen is yet to be determined.
Cite This Article
APA
Tomlinson JE, Byrne E, Pusterla N, Magdesian KG, Hilton HG, McGorum B, Davis E, Schoster A, Arroyo L, Dunkel B, Carslake H, Boston RC, Johnson AL.
(2015).
The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses: 25 Cases (2007-2012).
J Vet Intern Med, 29(5), 1403-1409.
https://doi.org/10.1111/jvim.13594 Publication
Researcher Affiliations
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
- Alamo Pintado Equine Medical Center, Los Olivos, CA.
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA.
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA.
- Departments of Structural Biology and Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA.
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK.
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada.
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada.
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Herts, UK.
- Philip Leverhulme Equine Hospital, University of Liverpool, Wirral, UK.
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
MeSH Terms
- Animals
- Anti-Bacterial Agents / therapeutic use
- Female
- Fibrinolytic Agents / therapeutic use
- Horse Diseases / diagnostic imaging
- Horse Diseases / drug therapy
- Horse Diseases / microbiology
- Horse Diseases / mortality
- Horses
- Male
- Pleuropneumonia, Contagious / diagnostic imaging
- Pleuropneumonia, Contagious / drug therapy
- Pleuropneumonia, Contagious / microbiology
- Pleuropneumonia, Contagious / mortality
- Recombinant Proteins / therapeutic use
- Retrospective Studies
- Survival Analysis
- Tissue Plasminogen Activator / therapeutic use
- Treatment Outcome
- Ultrasonography
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Citations
This article has been cited 1 times.- Hart JA, Badiei A, Lee YCG. Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime.. Respirol Case Rep 2019 Apr;7(3):e00408.
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