Treatment of hepatic veno-occlusive disease with low-dose tissue plasminogen activator: impact on coagulation profile.
Bone Marrow Transplant
; 18(3): 633-6, 1996 Sep.
Article
em En
| MEDLINE
| ID: mdl-8879629
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.
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Base de dados:
MEDLINE
Assunto principal:
Coagulação Sanguínea
/
Hepatopatia Veno-Oclusiva
/
Transplante de Medula Óssea
/
Ativador de Plasminogênio Tecidual
Limite:
Adolescent
/
Humans
/
Male
Idioma:
En
Revista:
Bone Marrow Transplant
Assunto da revista:
TRANSPLANTE
Ano de publicação:
1996
Tipo de documento:
Article
País de afiliação:
Estados Unidos