Alteplase Dose Assessment for Pleural infection Therapy (ADAPT) Study‐2: Use of 2.5 mg alteplase as a starting intrapleural dose

Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy is increasingly used in pleural infection. This study assesses the intrapleural use of 2.5 mg tPA/5 mg DNase for pleural infection. Consecutive patients with pleural infection treated with a starting regime of 2.5 mg tPA/5 mg DNase were included from two centres in Australia and UK. Escalation of tPA dose was permitted if clinical response was inadequate. Most (88.4%) were treated successfully and discharged from the hospital without surgery within 90 days. Six patients with significant comorbidities (e.g., advanced cancer) had an ongoing infection when palliated and died. Two patients experienced self‐limiting pleural bleeding and received a blood transfusion. A starting intrapleural regime of 2.5 mg tPA/5 mg DNase, with up‐titration, if needed, can be effective and deserves further exploration.