Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecularweight heparin

This retrospective cohort study of 462 consecutive adult allogeneic and aut ologous blood or marrow transplantation (BMT) patients compared the inciden ce of hepatic veno-occlusive disease (VOD) after BMT with three prophylacti c regimens. Patients receiving heparin (Hep), heparin + prostaglandin E1 (H ep + PGE1) or low molecular weight heparin (LMWH) as a prophylactic VOD reg imen were compared to a historical cohort receiving no VOD prophylaxis. Of 462 BMT patients, VOD was diagnosed in 22% (31 of 142) of the no prophylaxi s group, 11% (11 of 104) of the Hep, 12% (13 of 110) in the Hep + PGE1 and 4% (four of 106) of the LMWH group (P = 0.0002), VOD was the primary cause of death in 20% (12 of 59), By multivariate logistic regression, independen t risk factors for developing VOD were: no VOD prophylactic regimen, unrela ted allogeneic BMT, Karnofsky performance score (KPS) <80 and aspartate ami notransferase (AST) <greater than or equal to>50 U/l, There was no increase in the rate of death due to hemorrhagic events or VOD in any prophylaxis g roup compared to the control group. Prospective randomized trials of Hep vs LMWH vs placebo are warranted to assess the efficacy of heparin compounds in the prevention of VOD.