Optimal Pericardial Sclerosing Agent
Source: Liu G, et al. J Clin Oncol 14:3141-3147.
Recurrent malignant pericardial effusion with tamponade is a common problem that used to be treated effectively with tetracycline sclerosis, but this form of powdered tetracycline is no longer available in the United States. Alternative therapies used recently have been doxycycline and bleomycin, but no comparative prospective data of these two agents is available. Thus, Liu et al used each agent alternately in 27 patients undergoing catheter pericardial drainage for tamponade due to malignant effusion. Catheter dislodgment prevented sclerosis in six, 11 had bleomycin, and 10 had doxycycline. Successful sclerosis was achieved in all but one patient who died early, with median bleomycin doses of 20 mg and 1250 mg of doxycycline. One patient in each group failed sclerosis initially, but was successfully treated with the other agent. Doxycycline produced significant pain in 70% of the patients despite prophylactic intrapericardial lidocaine in all patients, whereas bleomycin produced none. Patients in both groups required a median of two installations (range, 1-4) to achieve sclerosis, but the doxycycline patients required a median of 3.5 more days of hospitalization (8.5 vs 5.0) and two more days of pericardial drainage (7 vs 5) compared to the bleomycin group. Tamponade recurred in one bleomycin patient at 253 days, but no doxycycline patients. Thus, largely due to reduced morbidity and hospital stays, the authors believe bleomycin is the sclerosing agent of choice despite its higher cost vs. doxycycline. Simple pericardiocentesis is not recommended in malignancy patients because of the high recurrence rate. Surgical pericardial window or balloon pericardiotomy are equally effective in preventing recurrences as compared to sclerosis, but cost and morbidity considerations would favor bleomycin sclerosis compared to these more invasive procedures as initial therapy.mhc
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