• • Surgical procedures (VATS or decortication ) will be reduced by at least 40% more with Activase than with placebo • Preventing recurrence of CPE within six weeks ( if effusion recurs with sepsis, needing medical therapy or interventional therapy) [ Time Frame: 3 TO 4 YEARS ] [ Designated as safety issue: Yes ]
  

• • A 70% reduction of complicated pleural effusion • Improvement of clinical symptoms • A 70% improvement in pneumonia, pulmonary infiltrates, and atelectasis • Shorten hospital stay • Prevent placing multiple chest tubes or repositioning chest [ Time Frame: 3- 4 YEARS ] [ Designated as safety issue: Yes ]
  

The current treatments available for CPE include chest tube placement for drainage and IV antibiotics. If this fails and CPE occurs then in most patients thoracotomy is performed. Patients that are not surgical candidates have image guided catheter placement performed, sometimes multiple times. The American College of Chest Physicians (ACCP) formed a CPE panel and published guidelines for treating CPE. Percutaneous image-guided drainage is the most common approach for CPE. The panel recognizes the cumulative data that supports the use of fibrinolytics, VATS, and thoracotomy. The CPE panel acknowledged the lack of randomized clinical trials to determine efficacy and safety of these modalities in CPE and strongly encourages the research to take place.

Fibrinolytic therapy is a relatively noninvasive, easy to use, and is relatively inexpensive. If successful, it will prevent sepsis and septic shock, decrease hospital stay, morbidity and mortality and prevent any surgical procedures. Multiple doses of fibrinolytics have been used in CPE with no evidence of systemic anti-fibrinolytic activity. Complications with these medications are also very uncommon and only isolated instances are reported. The benefit from successful pleural drainage using these agents will decrease morbidity, mortality, surgical procedures, and hospital stay.