Veno-occlusive disease prophylaxis with fresh frozen plasma and heparin in bone marrow transplantation
Veno-occlusive disease prophylaxis with fresh frozen plasma and heparin in bone marrow transplantation
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DOI：
10.1016/j.thromres.2005.10.010
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发表时间：
2006-01-01
影响因子：
7.5
通讯作者：
Anagnostopoulos, Achilles
中科院分区：
文献类型：
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作者：
Batsis, Ioannis;Yannaki, Evangelia;Anagnostopoulos, Achilles
新鲜冷冻血浆（FFP）含有天然抗凝剂，如抗凝血酶（AT）和蛋白C（Prot-C）。我们假设，除肝素外，给予FFP可能会替代调节期间发生的内源性抗凝剂的消耗，此外，校正的AT水平可以增强肝素的抗凝功能。因此，这可能导致有效的抗VOD预防。在这项研究中，我们回顾性分析了403例连续骨髓移植（BMTs）中肝VOD的发生率，比较了2种预防性方案和无预防性方案。患者在预处理期间未接受预防性治疗（70/403）、仅接受肝素治疗（27/403）或每日接受肝素+2FFP治疗（306/403）。肝素+FFP组（5.9%）的VOD显著低于肝素组（20%）和无预防组（15.7%）[p < 0.01]。第8天，VOD组的AT和Prot-C水平低于非VOD组（AT：69 +/- 26% vs. 89 +/-19%，Prot-C：68 +/- 26% vs. 91 +/-29%，p=0.001）。多因素Logistic回归分析显示，发生VOD的危险因素为：服用2种以上肝肾毒性药物、既往有B或C型肝炎病史和BMT数量。对198例患者（均记录有AT、Prot-C）进行多因素分析，证实为VOD相关因素、第8天Prot-C较低、BMT数量> 1和既往接受过腹部放疗。我们的研究表明，FFP在空调，除了肝素，可能有抗VOD的预防作用，大概是通过最大限度地减少下降的天然抗凝剂在第8天左右。为了评估肝素+FFP预防VOD是否真的有益，我们启动了一项前瞻性随机试验。(c)2005爱思唯尔有限公司保留所有权利。
Fresh frozen plasma (FFP) contains natural anticoagulants, such as antithrombin (AT) and Protein C (Prot-C). We hypothesized that FFP given in addition to heparin, could potentially replace the consumption of endogenous anticoagulants occurring during conditioning and moreover, corrected AT levels could augment heparin's anticoagulant function. This could therefore result in an effective anti-VOD prophylaxis. In this study, we retrospectively analyzed the incidence of hepatic VOD in 403 consecutive bone marrow transplants (BMTs) comparing 2 prophylactic regimens and no prophylaxis. Patients received no prophylaxis (70/403), heparin-only (27/403) or heparin+2FFP daily during conditioning (306/403). VOD was significantly lower in the heparin+FFP group (5.9%) compared to heparin (20%) and no prophylaxis group (15.7%) [p < 0.01]. Day 8 AT and Prot-C levels, were lower in the VOD- compared to the non-VOD group (AT: 69 +/- 26% vs. 89 +/- 19%, Prot-C:68 +/- 26% vs. 91 +/- 29%, respectively, p=0.001). In a multivariate logistic regression, risk factors for developing VOD were: the administration of > 2 hepato-nephrotoxic drugs, previous history of hepatitis B or C and number of BMT Multivariate analysis in a subset of 198 patients (all having recorded AT, Prot-C), demonstrated as VOD-related factors, the low day 8 Prot-C, number of BMT > 1 and prior abdominal radiotherapy. Our study implies that FFP during conditioning, in addition to heparin, potentially has an anti-VOD prophylactic effect, presumably by minimizing the drop of natural anticoagulants around day 8. In order to evaluate if there truely is a beneficial effect of heparin+FFP in VOD prophylaxis, we have initiated a prospective randomized trial. (c) 2005 Elsevier Ltd. All rights reserved.