{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:37:33Z","timestamp":1781642253851,"version":"3.54.5"},"reference-count":77,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2027,2,9]],"date-time":"2027-02-09T00:00:00Z","timestamp":1802131200000},"content-version":"am","delay-in-days":373,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100014450","name":"University of Colorado Anschutz Medical Campus","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014450","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["P20-GM152326"],"award-info":[{"award-number":["P20-GM152326"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010174","name":"University of Colorado","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010174","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart Lung and Blood Institute","doi-asserted-by":"publisher","award":["K08-HL171936"],"award-info":[{"award-number":["K08-HL171936"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005834","name":"Francis Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005834","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100029376","name":"Shock Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100029376","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal.chestnet.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["CHEST"],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.1016\/j.chest.2025.08.027","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:01:00Z","timestamp":1757548860000},"page":"360-370","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intrapleural Fibrinolytic Therapy"],"prefix":"10.1016","volume":"169","author":[{"given":"Peter K.","family":"Moore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Hershberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9720-8155","authenticated-orcid":false,"given":"Christopher D.","family":"Barrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1084\/jem.58.4.485","article-title":"The fibrinolytic activity of hemolytic streptococci","volume":"58","author":"Tillett","year":"1933","journal-title":"J Exp Med"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1172\/JCI102046","article-title":"The effect in patients of streptococcal fibrinolysin (streptokinase) and streptococcal desoxyribonuclease on fibrinous, purulent, and sanguinous pleural exudations 1","volume":"28","author":"Tillett","year":"1949","journal-title":"J Clin Invest"},{"issue":"18","key":"10.1016\/j.chest.2025.08.027_bib3","doi-asserted-by":"crossref","DOI":"10.3390\/ijms241814179","article-title":"The fibrinolytic system and its measurement: history, current uses and future directions for diagnosis and treatment","volume":"24","author":"Hvas","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib4","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1113\/jphysiol.1887.sp000265","article-title":"Note on the action of sodium chloride in dissolving fibrin","volume":"8","author":"Green","year":"1887","journal-title":"J Physiol"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib5","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1136\/thx.52.5.416","article-title":"Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection","volume":"52","author":"Davies","year":"1997","journal-title":"Thorax"},{"key":"10.1016\/j.chest.2025.08.027_bib6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4049\/jimmunol.42.2.109","article-title":"A factor in normal human blood which participates in streptococcal fibrinolysis","volume":"42","author":"Milstone","year":"1941","journal-title":"J Immunol"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib7","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1085\/jgp.28.6.559","article-title":"A proteolytic enzyme of serum: characterization, activation, and reaction with inhibitors","volume":"28","author":"Christensen","year":"1945","journal-title":"J Gen Physiol"},{"issue":"12","key":"10.1016\/j.chest.2025.08.027_bib8","first-page":"1019","article-title":"Intrapleural streptokinase in management of parapneumonic effusions: report of series and review of literature","volume":"76","author":"Mitchell","year":"1989","journal-title":"J Fla Med Assoc"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib9","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1378\/chest.105.3.868","article-title":"Intrapleural urokinase in the treatment of loculated pleural effusions","volume":"105","author":"Pollak","year":"1994","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib10","doi-asserted-by":"crossref","first-page":"649","DOI":"10.2214\/ajr.167.3.8751672","article-title":"Transcatheter instillation of urokinase into loculated pleural effusion: analysis of treatment effect","volume":"167","author":"Park","year":"1996","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib11","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1148\/radiology.179.3.2027990","article-title":"Treatment of thoracic multiloculated empyemas with intracavitary urokinase: a prospective study","volume":"179","author":"Lee","year":"1991","journal-title":"Radiology"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib12","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1378\/chest.108.5.1252","article-title":"Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase","volume":"108","author":"Moulton","year":"1995","journal-title":"Chest"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib13","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1164\/ajrccm.155.1.9001327","article-title":"Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study","volume":"155","author":"Bouros","year":"1997","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1164\/ajrccm.159.1.9803094","article-title":"Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema: a randomized, double-blind study","volume":"159","author":"Bouros","year":"1999","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib15","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1164\/rccm.200312-1740OC","article-title":"Intrapleural streptokinase for empyema and complicated parapneumonic effusions","volume":"170","author":"Diacon","year":"2004","journal-title":"Am J Respir Crit Care Med"},{"issue":"9","key":"10.1016\/j.chest.2025.08.027_bib16","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1056\/NEJMoa042473","article-title":"U.K. Controlled trial of intrapleural streptokinase for pleural infection","volume":"352","author":"Maskell","year":"2005","journal-title":"N Engl J Med"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib17","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1056\/NEJMoa1012740","article-title":"Intrapleural use of tissue plasminogen activator and DNase in pleural infection","volume":"365","author":"Rahman","year":"2011","journal-title":"N Engl J Med"},{"key":"10.1016\/j.chest.2025.08.027_bib18","first-page":"464","article-title":"Utility of intrapleural streptokinase in management of chronic empyemas","volume":"51","author":"Talib","year":"2003","journal-title":"J Assoc Physicians India"},{"issue":"10","key":"10.1016\/j.chest.2025.08.027_bib19","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1111\/j.1742-1241.2001.tb11156.x","article-title":"Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial","volume":"55","author":"Tuncozgur","year":"2001","journal-title":"Int J Clin Pract"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib20","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S0741-5214(95)70045-5","article-title":"Comparison of streptokinase, urokinase, and recombinant tissue plasminogen activator in an in vitro model of venous thrombolysis","volume":"22","author":"Ouriel","year":"1995","journal-title":"J Vasc Surg"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib21","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1097\/01.TA.0000141879.67441.52","article-title":"Intrapleural tissue plasminogen activator for complicated pleural effusions","volume":"57","author":"Skeete","year":"2004","journal-title":"J Trauma"},{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib22","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1136\/thorax.58.4.365","article-title":"Successful treatment of empyema thoracis with human recombinant deoxyribonuclease","volume":"58","author":"Simpson","year":"2003","journal-title":"Thorax"},{"issue":"suppl 3","key":"10.1016\/j.chest.2025.08.027_bib23","doi-asserted-by":"crossref","first-page":"s1","DOI":"10.1136\/thorax-2022-219784","article-title":"British Thoracic Society Guideline for pleural disease","volume":"78","author":"Roberts","year":"2023","journal-title":"Thorax"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib24","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1093\/ejcts\/ezv272","article-title":"EACTS expert consensus statement for surgical management of pleural empyema","volume":"48","author":"Scarci","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib25","doi-asserted-by":"crossref","first-page":"00590","DOI":"10.1183\/23120541.00590-2021","article-title":"An international survey on the use of intrapleural tissue plasminogen activator\/DNase therapy for pleural infection","volume":"8","author":"Lau","year":"2022","journal-title":"ERJ Open Res"},{"issue":"7","key":"10.1016\/j.chest.2025.08.027_bib26","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/resp.14261","article-title":"Alteplase Dose Assessment for Pleural infection Therapy (ADAPT) Study-2: use of 2.5 mg alteplase as a starting intrapleural dose","volume":"27","author":"Popowicz","year":"2022","journal-title":"Respirology"},{"issue":"2","key":"10.1016\/j.chest.2025.08.027_bib27","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1159\/000443334","article-title":"Management of intrapleural sepsis with once daily use of tissue plasminogen activator and deoxyribonuclease","volume":"91","author":"Mehta","year":"2016","journal-title":"Respiration"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib28","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1164\/ajrccm.157.1.97-03094","article-title":"The systemic fibrinolytic activity of intrapleural streptokinase","volume":"157","author":"Davies","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib29","doi-asserted-by":"crossref","first-page":"91","DOI":"10.21037\/jtd-23-847","article-title":"Understanding the systemic effects of intrapleural tPA and DNase by evaluating effects on coagulation","volume":"16","author":"Marston","year":"2024","journal-title":"J Thorac Dis"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib30","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1148\/radiol.2463070235","article-title":"Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage","volume":"246","author":"Gervais","year":"2008","journal-title":"Radiology"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib31","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.chest.2022.06.008","article-title":"Bleeding risk with combination intrapleural fibrinolytic and enzyme therapy in pleural infection: an international, multicenter, retrospective cohort study","volume":"162","author":"Akulian","year":"2022","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib32","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1378\/chest.13-1558","article-title":"A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection","volume":"145","author":"Rahman","year":"2014","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib33","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.chest.2021.05.026","article-title":"Epidemiology of adult pleural disease in the United States","volume":"160","author":"Mummadi","year":"2021","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib34","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.03546-2020","article-title":"Epidemiology of pleural empyema in English hospitals and the impact of influenza","volume":"57","author":"Arnold","year":"2021","journal-title":"Eur Respir J"},{"issue":"2","key":"10.1016\/j.chest.2025.08.027_bib35","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jtcvs.2006.09.038","article-title":"Management of pleural space infections: a population-based analysis","volume":"133","author":"Farjah","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib36","article-title":"Optimal timing for video assisted thoracic surgery decortication for improved survival in chronic empyema","volume":"14","author":"Lin","year":"2024","journal-title":"Sci Rep"},{"issue":"8","key":"10.1016\/j.chest.2025.08.027_bib37","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1136\/thx.2010.156406","article-title":"Emergence of parapneumonic empyema in the USA","volume":"66","author":"Grijalva","year":"2011","journal-title":"Thorax"},{"key":"10.1016\/j.chest.2025.08.027_bib38","article-title":"Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema","volume":"10","author":"Altmann","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"10.1016\/j.chest.2025.08.027_bib39","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01550-2018","article-title":"Cost-effectiveness of intrapleural use of tissue plasminogen activator and DNase in pleural infection: evidence from the MIST2 randomised controlled trial","volume":"54","author":"Luengo-Fernandez","year":"2019","journal-title":"Eur Respir J"},{"key":"10.1016\/j.chest.2025.08.027_bib40","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2021.806393","article-title":"From bedside to the bench\u2014a call for novel approaches to prognostic evaluation and treatment of empyema","volume":"12","author":"Karandashova","year":"2022","journal-title":"Front Pharmacol"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib41","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1016\/j.jtcvs.2017.01.030","article-title":"The American Association for Thoracic Surgery consensus guidelines for the management of empyema","volume":"153","author":"Shen","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"9","key":"10.1016\/j.chest.2025.08.027_bib42","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S2213-2600(20)30533-6","article-title":"Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement","volume":"9","author":"Chaddha","year":"2021","journal-title":"Lancet Respir Med"},{"issue":"11","key":"10.1016\/j.chest.2025.08.027_bib43","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1513\/AnnalsATS.202108-964OC","article-title":"Comparing initial surgery versus fibrinolytics for pleural space infections: a retrospective multicenter cohort study","volume":"19","author":"Wilshire","year":"2022","journal-title":"Ann Am Thorac Soc"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib44","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.athoracsur.2009.01.028","article-title":"Choice of first intervention is related to outcomes in the management of empyema","volume":"87","author":"Wozniak","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"10.1016\/j.chest.2025.08.027_bib45","first-page":"00619","article-title":"Enzymatic therapy versus video-assisted thoracoscopic surgery for pleural infections: a systematic review and meta-analysis","volume":"11","author":"de Jonge","year":"2025","journal-title":"ERJ Open Res"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib46","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1378\/chest.111.6.1548","article-title":"A randomized trial of empyema therapy","volume":"111","author":"Wait","year":"1997","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib47","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/j.1445-2197.2006.03666.x","article-title":"Benefits of early aggressive management of empyema thoracis","volume":"76","author":"Bilgin","year":"2006","journal-title":"ANZ J Surg"},{"issue":"8","key":"10.1016\/j.chest.2025.08.027_bib48","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1513\/AnnalsATS.202001-076OC","article-title":"Intrapleural fibrinolytic therapy versus early medical thoracoscopy for treatment of pleural infection: randomized controlled clinical trial","volume":"17","author":"Kheir","year":"2020","journal-title":"Ann Am Thorac Soc"},{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib49","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.7799","article-title":"Effect of intrapleural fibrinolytic therapy vs surgery for complicated pleural infections: a randomized clinical trial","volume":"6","author":"Wilshire","year":"2023","journal-title":"JAMA Network Open"},{"key":"10.1016\/j.chest.2025.08.027_bib50","unstructured":"Bedawi EO, Stavroulias D, Hedley E, et al. Early video-assisted thoracoscopic surgery or intrapleural enzyme therapy in pleural infection: a feasibility randomized controlled trial. The Third Multicenter Intrapleural Sepsis Trial\u2014MIST-3. Am J Respir Crit Care Med. 208(12):1305-1315."},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib77","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054236","article-title":"Intrapleural fibrinolysis and DNase versus video-assisted thoracic surgery (VATS) for the treatment of pleural empyema (FIVERVATS): protocol for a randomised, controlled trial - surgery as first-line treatment","volume":"12","author":"Christensen","year":"2022","journal-title":"BMJ Open"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib51","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054236","article-title":"Intrapleural fibrinolysis and DNase versus video-assisted thoracic surgery (VATS) for the treatment of pleural empyema (FIVERVATS): protocol for a randomised, controlled trial\u2014surgery as first-line treatment","volume":"12","author":"Christensen","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib52","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.chest.2024.04.005","article-title":"Neutrophil-mediated inflammatory plasminogen degradation, rather than high plasminogen-activator inhibitor-1, may underly failures and inefficiencies of intrapleural fibrinolysis","volume":"167","author":"Barrett","year":"2025","journal-title":"Chest"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib53","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1164\/ajrccm\/144.1.187","article-title":"Abnormalities of pathways of fibrin turnover in the human pleural space","volume":"144","author":"Idell","year":"1991","journal-title":"Am Rev Respir Dis"},{"issue":"8","key":"10.1016\/j.chest.2025.08.027_bib54","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1183\/09031936.95.08081352","article-title":"Fibrinolytic and inflammatory processes in pleural effusions","volume":"8","author":"Philip-Joet","year":"1995","journal-title":"Eur Respir J"},{"issue":"10","key":"10.1016\/j.chest.2025.08.027_bib55","doi-asserted-by":"crossref","DOI":"10.1172\/jci.insight.127470","article-title":"Phase 1 trial of intrapleural LTI-01; single chain urokinase in complicated parapneumonic effusions or empyema","volume":"5","author":"Beckert","year":"2019","journal-title":"JCI Insight"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib56","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1164\/rccm.202206-1084OC","article-title":"The biological role of pleural fluid PAI-1 and sonographic septations in pleural infection: analysis of a prospectively collected clinical outcome study","volume":"207","author":"Bedawi","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib57","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.3390\/pharmaceutics15051498","article-title":"Targeting the PAI-1 mechanism with a small peptide increases the efficacy of alteplase in a rabbit model of chronic empyema","volume":"15","author":"Florova","year":"2023","journal-title":"Pharmaceutics"},{"issue":"4","key":"10.1016\/j.chest.2025.08.027_bib58","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1165\/rcmb.2014-0168OC","article-title":"Targeting of plasminogen activator inhibitor 1 improves fibrinolytic therapy for tetracycline-induced pleural injury in rabbits","volume":"52","author":"Florova","year":"2015","journal-title":"Am J Respir Cell Mol Biol"},{"issue":"12","key":"10.1016\/j.chest.2025.08.027_bib59","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1164\/rccm.201911-2169OC","article-title":"Pleural fluid suPAR levels predict the need for invasive management in parapneumonic effusions","volume":"201","author":"Arnold","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"21","key":"10.1016\/j.chest.2025.08.027_bib60","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1182\/blood.2020008951","article-title":"Plasminogen: an enigmatic zymogen","volume":"137","author":"Keragala","year":"2021","journal-title":"Blood"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib61","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1164\/ajrccm.157.5.9711116","article-title":"Interleukin-8 and markers of neutrophil degranulation in pleural effusions","volume":"157","author":"Segura","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib62","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1183\/09031936.04.00010504","article-title":"Metalloproteinases and tissue inhibitors of metalloproteinases in exudative pleural effusions","volume":"25","author":"Iglesias","year":"2005","journal-title":"Eur Respir J"},{"issue":"5","key":"10.1016\/j.chest.2025.08.027_bib63","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.chest.2021.07.026","article-title":"Parapneumonic effusions are characterized by elevated levels of neutrophil extracellular traps","volume":"160","author":"Twaddell","year":"2021","journal-title":"Chest"},{"issue":"8","key":"10.1016\/j.chest.2025.08.027_bib64","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1038\/nm.2184","article-title":"Reciprocal coupling of coagulation and innate immunity via neutrophil serine proteases","volume":"16","author":"Massberg","year":"2010","journal-title":"Nat Med"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib65","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1159\/000087366","article-title":"Factors influencing length of hospital stay in patients with bacterial pleural effusion","volume":"72","author":"Soriano","year":"2005","journal-title":"Respiration"},{"issue":"6","key":"10.1016\/j.chest.2025.08.027_bib66","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1097\/TA.0000000000001685","article-title":"Human neutrophil elastase mediates fibrinolysis shutdown through competitive degradation of plasminogen and generation of angiostatin","volume":"83","author":"Barrett","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib67","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1182\/blood.V86.3.1056.1056","article-title":"The cleavage and inactivation of plasminogen activator inhibitor type 1 by neutrophil elastase: the evaluation of its physiologic relevance in fibrinolysis","volume":"86","author":"Wu","year":"1995","journal-title":"Blood"},{"issue":"16","key":"10.1016\/j.chest.2025.08.027_bib68","doi-asserted-by":"crossref","first-page":"9849","DOI":"10.1016\/S0021-9258(18)34149-8","article-title":"Proteolytic cleavage and inactivation of alpha 2-plasmin inhibitor and C1 inactivator by human polymorphonuclear leukocyte elastase","volume":"257","author":"Brower","year":"1982","journal-title":"J Biol Chem"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib69","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.chest.2024.10.022","article-title":"Plasminogen: the not-as-obvious but obvious choice for lytic therapy","volume":"167","author":"Kim","year":"2025","journal-title":"Chest"},{"issue":"14","key":"10.1016\/j.chest.2025.08.027_bib70","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/j.jcin.2018.04.008","article-title":"A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE Trial","volume":"11","author":"Tapson","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib71","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/TA.0000000000004324","article-title":"Thoracic cavity irrigation prevents retained hemothorax and decreases surgical intervention in trauma patients","volume":"97","author":"Al Tannir","year":"2024","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"10.1016\/j.chest.2025.08.027_bib72","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1183\/09031936.00147214","article-title":"Pleural Irrigation Trial (PIT): a randomised controlled trial of pleural irrigation with normal saline versus standard care in patients with pleural infection","volume":"46","author":"Hooper","year":"2015","journal-title":"Eur Respir J"},{"issue":"3","key":"10.1016\/j.chest.2025.08.027_bib73","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/s1010-7940(02)00803-5","article-title":"Thoracoscopical water jet lavage in coagulated hemothorax","volume":"23","author":"Tomaselli","year":"2003","journal-title":"Eur J Cardiothorac Surg"},{"issue":"11","key":"10.1016\/j.chest.2025.08.027_bib74","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.21037\/jtd.2016.11.93","article-title":"A simple weighted scoring system to guide surgical decision-making in patients with parapneumonic pleural effusion","volume":"8","author":"Chang","year":"2016","journal-title":"J Thorac Dis"},{"issue":"12","key":"10.1016\/j.chest.2025.08.027_bib75","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1055\/a-2508-3424","article-title":"A novel fibrinolysis resistance capacity assay can detect fibrinolytic phenotypes in trauma patients","volume":"125","author":"Barrett","year":"2025","journal-title":"Thromb Haemost"},{"issue":"1","key":"10.1016\/j.chest.2025.08.027_bib76","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/jth.15114","article-title":"Application of a plasmin generation assay to define pharmacodynamic effects of tranexamic acid in women undergoing cesarean delivery","volume":"19","author":"Miszta","year":"2021","journal-title":"J Thromb Haemost"}],"container-title":["CHEST"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369225051839?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369225051839?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:42:24Z","timestamp":1776732144000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0012369225051839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":77,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["S0012369225051839"],"URL":"https:\/\/doi.org\/10.1016\/j.chest.2025.08.027","relation":{},"ISSN":["0012-3692"],"issn-type":[{"value":"0012-3692","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Intrapleural Fibrinolytic Therapy","name":"articletitle","label":"Article Title"},{"value":"CHEST","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.chest.2025.08.027","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 American College of Chest Physicians. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}