Sinusoidal obstruction syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

The management of sinusoidal obstruction syndrome depends on the severity of the disease. However, supportive care is the mainstay of therapy for mild and moderate sinusoidal obstruction syndrome. The severe form of sinusoidal obstruction syndrome needs defibrotide (thrombolytic agent) along with supportive care. Patients are advised to avoid supplements and medications that are linked to hepatic injury.

Medical Therapy

The management of sinusoidal obstruction syndrome depends on the severity of the disease.^[1]
Supportive care is the mainstay of treatment.^[2]
Supportive measures include:
- Maintaining intravascular volume
- Avoidance of hepatotoxic agents
- Paracentesis can be done to remove ascitic fluid
- Narcotics can be used to keep patient pain free.
Patients with mild to moderate sinusoidal obstruction syndrome can be treated with supportive care alone. However, severe cases need defibrotide (thrombolytic agent) along with supportive care.^[3]^[4]

Parameters	Mild	Moderate	Severe
Serum total bilirubin	<5 mg/dL	< (5.1 to 8 mg/dL	>8 mg/dL
Serum aspartate aminotransferase (AST)	<3 x normal	3 to 8 x normal	>8 x normal
Weight above baseline	<2 percent	2 to 5 percent	>5 percent
Serum creatinine	Normal	<2 x normal	>2 x normal
Rate of change	Slow (over 6–7 d)	(over 4–5 d)	Rapid (over2–3 d)

References

↑ Chopra R, Eaton JD, Grassi A, Potter M, Shaw B, Salat C, Neumeister P, Finazzi G, Iacobelli M, Bowyer K, Prentice HG, Barbui T (2000). “Defibrotide for the treatment of hepatic veno-occlusive disease: results of the European compassionate-use study”. Br. J. Haematol. 111 (4): 1122–9. PMID 11167751.
↑ Richardson PG, Elias AD, Krishnan A, Wheeler C, Nath R, Hoppensteadt D, Kinchla NM, Neuberg D, Waller EK, Antin JH, Soiffer R, Vredenburgh J, Lill M, Woolfrey AE, Bearman SI, Iacobelli M, Fareed J, Guinan EC (1998). “Treatment of severe veno-occlusive disease with defibrotide: compassionate use results in response without significant toxicity in a high-risk population”. Blood. 92 (3): 737–44. PMID 9680339.
↑ Richardson PG, Murakami C, Jin Z, Warren D, Momtaz P, Hoppensteadt D, Elias AD, Antin JH, Soiffer R, Spitzer T, Avigan D, Bearman SI, Martin PL, Kurtzberg J, Vredenburgh J, Chen AR, Arai S, Vogelsang G, McDonald GB, Guinan EC (2002). “Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure: response without significant toxicity in a high-risk population and factors predictive of outcome”. Blood. 100 (13): 4337–43. doi:10.1182/blood-2002-04-1216. PMID 12393437.
↑ Corbacioglu S, Greil J, Peters C, Wulffraat N, Laws HJ, Dilloo D, Straham B, Gross-Wieltsch U, Sykora KW, Ridolfi-Lüthy A, Basu O, Gruhn B, Güngör T, Mihatsch W, Schulz AS, Strahm B (2004). “Defibrotide in the treatment of children with veno-occlusive disease (VOD): a retrospective multicentre study demonstrates therapeutic efficacy upon early intervention”. Bone Marrow Transplant. 33 (2): 189–95. doi:10.1038/sj.bmt.1704329. PMID 14661036.

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[pmid11167751-1] Chopra R, Eaton JD, Grassi A, Potter M, Shaw B, Salat C, Neumeister P, Finazzi G, Iacobelli M, Bowyer K, Prentice HG, Barbui T (2000). “Defibrotide for the treatment of hepatic veno-occlusive disease: results of the European compassionate-use study”. Br. J. Haematol. 111 (4): 1122–9. PMID 11167751.

[pmid9680339-2] Richardson PG, Elias AD, Krishnan A, Wheeler C, Nath R, Hoppensteadt D, Kinchla NM, Neuberg D, Waller EK, Antin JH, Soiffer R, Vredenburgh J, Lill M, Woolfrey AE, Bearman SI, Iacobelli M, Fareed J, Guinan EC (1998). “Treatment of severe veno-occlusive disease with defibrotide: compassionate use results in response without significant toxicity in a high-risk population”. Blood. 92 (3): 737–44. PMID 9680339.

[pmid12393437-3] Richardson PG, Murakami C, Jin Z, Warren D, Momtaz P, Hoppensteadt D, Elias AD, Antin JH, Soiffer R, Spitzer T, Avigan D, Bearman SI, Martin PL, Kurtzberg J, Vredenburgh J, Chen AR, Arai S, Vogelsang G, McDonald GB, Guinan EC (2002). “Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure: response without significant toxicity in a high-risk population and factors predictive of outcome”. Blood. 100 (13): 4337–43. doi:10.1182/blood-2002-04-1216. PMID 12393437.

[pmid14661036-4] Corbacioglu S, Greil J, Peters C, Wulffraat N, Laws HJ, Dilloo D, Straham B, Gross-Wieltsch U, Sykora KW, Ridolfi-Lüthy A, Basu O, Gruhn B, Güngör T, Mihatsch W, Schulz AS, Strahm B (2004). “Defibrotide in the treatment of children with veno-occlusive disease (VOD): a retrospective multicentre study demonstrates therapeutic efficacy upon early intervention”. Bone Marrow Transplant. 33 (2): 189–95. doi:10.1038/sj.bmt.1704329. PMID 14661036.

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Sinusoidal obstruction syndrome medical therapy

Overview

Medical Therapy

References

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