TREATMENT OF HEPATIC VENOOCCLUSIVE DISEASE WITH LOW-DOSE TISSUE-PLASMINOGEN ACTIVATOR - IMPACT ON COAGULATION PROFILE

An 18-year-old white male developed severe hepatic veno-occlusive dise ase (VOD) during an autologous bone marrow transplant for primary refr actory nodular sclerosing Hodgkin's disease, As a result of VOD-induce d hepatic dysfunction, coagulation studies revealed depression of vita min K dependent procoagulant factor VII. Intravenous recombinant tissu e plasminogen activator 20 mg over 4 h on 4 consecutive days and conti nuous heparin infusion (1000 unit bolus followed by 150 units/kg/day) resulted in rapid reversal of the VOD syndrome, During treatment, proc oagulant factors II, VII, IX and X levels increased indicating the ret urn of hepatic synthesizing capacity, Factor V levels, which were elev ated pre-therapy, also rose dramatically, Plasma antigen levels of pro tein C, a natural anticoagulant, remained severely depressed, No clini cal evidence of bleeding and only minimal systemic fibrinolysis was no ted, Despite concerns regarding the use of lytic therapy in a thromboc ytopenic post-BMT patient, serial measurements of coagulation paramete rs during severe VOD suggested that low dose rt-PA improved portions o f the systemic hemostatic profile.