OPA15 A NOVEL, COST-EFFECTIVE INTRAPLEURAL FIBRINOLYTIC REGIMEN: ALTEPLASE-TACHOLIQUINE PREVENTS SURGICAL REFERRAL IN 90% OF COMPLEX PLEURAL EFFUSIONS - A PILOT STUDY

Vijayan Munusamy¹, Liam CK¹, Pang YK¹, Wong CK¹, Mohamed Faisal², Tan JL¹, Loh TC¹, Earnest Poh ¹, Sia LC¹, Husna Ibrahim¹, Andrew Yeoh¹.
¹Department of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur (Malaysia).
¹Respiratory Unit, Faculty of Medicine, University Kebangsaan Malaysia (UKM), (Malaysia)

Background
In Malaysia, standard intrapleural fibrinolytic therapy (IPFT) using Pulmozyme is often inaccessible due to cost and import barriers. We conducted the first pilot project  evaluating a novel, locally sustainable regimen combining alteplase with low-cost tacholiquine.

Methods
A retrospective analysis of 20 consecutive patients (2023–2025) with loculated effusions/empyema (Stage II/III) persisting after pigtail drainage. Patients received intrapleural alteplase (2.5–10 mg) and tacholiquine (25 mg) twice daily for 4–6 doses. Outcomes included radiological resolution, VATS avoidance, safety, and cost analysis.

Results
Cohort characteristics: median age 63 (IQR:45–81), 75% male, effusion etiologies: bacterial (70%), tuberculosis (10%), malignant (20%). Key findings: Radiological improvement: 85% median reduction (IQR:70–95%),VATS avoidance: 18/20 patients (90%); both failures were bacterial effusions

Safety: Only 2 cases of minor bleeding (no transfusion required)

Cost: 45% savings vs. Pulmozyme (RM2750 vs.RM3650/course)

Hospital stay: Median 9 days post-therapy

Conclusion
This first-in-country pilot project demonstrates that alteplase-tacholiquine is a safe, effective, and economically transformative alternative for complex pleural effusions, preventing surgery in 90% of cases. Our protocol addresses systemic barriers to care in Malaysia and provides a template for national scale-up. Prospective trials are planned to refine dosing.