Treatment of hepatic veno-occlusive disease with low-dose tissue plasminogen activator: impact on coagulation profile.

Abstract

An 18-year-old white male developed severe hepatic veno-occlusive disease (VOD) during an autologous bone marrow transplant for primary refractory nodular sclerosing Hodgkin's disease. As a result of VOD-induced hepatic dysfunction, coagulation studies revealed depression of vitamin K dependent procoagulant factor VII. Intravenous recombinant tissue plasminogen activator 20 mg over h on 4 consecutive days and continuous heparin infusion (1000 unit bolus followed by 150 units/kg/day) resulted in rapid reversal of the VOD syndrome. During treatment, procoagulant factors II, VII, IX and X levels increased indicating the return of hepatic synthesizing capacity. Factor V levels, which were elevated pre-therapy, also rose dramatically. Plasma antigen levels of protein C, a natural anticoagulant, remained severely depressed. No clinical evidence of bleeding and only minimal systemic fibrinolysis was noted. Despite concerns regarding the use of lytic therapy in a thrombocytopenic post-BMT patient, serial measurements of coagulation parameters during severe VOD suggested that low dose rt-PA improved portions of the systemic hemostatic profile.

• Authors: S L Goldberg, J Shubert, A K Rao, I Redei, T R Klumpp, K F Mangan
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 18 Issue 3 Pg. 633-6 (Sep 1996) ISSN: 0268-3369 [Print] England
• PMID: 8879629 (Publication Type: Case Reports, Journal Article)

Chemical References

• Recombinant Proteins
• Tissue Plasminogen Activator

Topics

• Adolescent
• Blood Coagulation (drug effects)
• Bone Marrow Transplantation (adverse effects)
• Hepatic Veno-Occlusive Disease (drug therapy)
• Humans
• Male
• Recombinant Proteins (therapeutic use)
• Tissue Plasminogen Activator (therapeutic use)