Cochrane · systematic review · CD002312
Intra‐pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema
Altmann, ES, Crossingham, I, Wilson, S, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
AirwaysAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
12
current version
GRADE rated
12
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 1 · 8.3%Low 10 · 83.3%Moderate 1 · 8.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Fibrinolytics compared to placebo in the treatment of complicated parapneumonic effusions and empyema
Population: adult parapneumonic effusions and empyema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality. Fibrinolytics vs placebo | OR 1.16 [0.71, 1.91] | 8 studies · 867 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Referral for thoracic surgery. Fibrinolytics vs placebo | OR 0.37 [0.21, 0.68] | 8 studies · 897 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Overall treatment failure, including mortality, thoracic surgery or referral for further fibrinolytic therapy. Fibrinolytics vs placebo | OR 0.16 [0.05, 0.58] | 7 studies · 769 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Serious adverse events Fibrinolytics vs placebo | OR 1.28 [0.36, 4.57] | 9 studies · 935 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Streptokinase compared to urokinase in addition to chest drainage in the treatment of adult parapneumonic effusions and empyema
Population: adult parapneumonic effusions and empyema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Streptokinase vs urokinase | OR 0.32 [0.01, 8.25] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Referral for thoracic surgery (open or thorascopic) Streptokinase vs urokinase | OR 1 [0.13, 7.72] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Overall treatment failure, including mortality, thoracic surgery or referral for further fibrinolytic therapy Streptokinase vs urokinase | OR 1 [0.13, 7.72] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events Streptokinase vs urokinase | OR 5.43 [0.25, 118.96] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Alteplase compared to urokinase in addition to chest drainage in the treatment of adult parapneumonic effusions and empyema
Population: adult parapneumonic effusions and empyema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Alteplase vs urokinase | OR 0.94 [0.18, 4.89] | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Referral for thoracic surgery (open or thorascopic) Alteplase vs urokinase | OR 0.46 [0.04, 5.24] | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Overall treatment failure, including mortality, thoracic surgery or referral for further fibrinolytic therapy Alteplase vs urokinase | OR 3.02 [0.89, 10.27] | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events Alteplase vs urokinase | OR 5.61 [1.16, 27.11] | 1 study · 99 participants | Low Downgraded: risk of bias, imprecision |