Sinusoidal obstruction syndrome medical therapy

Jump to: navigation, search

Sinusoidal obstruction syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Sinusoidal obstruction syndrome from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sinusoidal obstruction syndrome medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sinusoidal obstruction syndrome medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sinusoidal obstruction syndrome medical therapy

CDC on Sinusoidal obstruction syndrome medical therapy

Sinusoidal obstruction syndrome medical therapy in the news

Blogs on Sinusoidal obstruction syndrome medical therapy

Directions to Hospitals Treating Sinusoidal obstruction syndrome

Risk calculators and risk factors for 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:
  • 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

  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.
  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.
  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.
  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.



Linked-in.jpg