Novel Insights Explaining Failure of Intrapleural Fibrinolytic Therapy in rHTX

Background: Retained hemothorax (rHTX) refers to blood products within the pleural cavity persisting beyond 72 hours after trauma. Following failed chest tube drainage, intrapleural fibrinolytic therapy (IPFT) offers a nonoperative alternative and involves administering tissue plasminogen activator (tPA) into the pleural space. Failure rates remain high at 20% to 25%. The pathophysiology of rHTX is a complex interplay between inflammation and coagulation. Objective: To investigate the underlying biomolecular pathology in rHTX using pleural fluid and circulating plasma from patients with traumatic hemothorax. Design: Prospective cohort study. Participants: Adult trauma patients with rHTX from a level 1 trauma center between May 2024 and January 2025. Methods: Hemothorax fluid from pleural space was collected at the time of surgery or chest tube placement, and blood plasma was obtained from peripheral venipuncture. Plasminogen activator inhibitor 1 (PAI-1) activity was measured in the more...