[Hypercoagulability in patients with veno-occlusive disease after bone marrow transplantation].
BACKGROUND
Veno-occlusive disease (VOD) leads to obliteration of small intrahepatic venules and is one of three most important complications with fatal outcome after bone marrow transplantation (BMT). The etiology of VOD is not completely understood. Endothelial cell injury induced by the conditioning myeloablative radiochemotherapy with subsequent activation of the coagulation cascade seems to be a crucial step in the pathogenesis of the disease.


METHODS
We investigated tissue plasminogen activator (tPA), its main inhibitor (PAI-1) and the natural anticoagulants protein C and S by enzymimmunoassay prospectively in 32 bone marrow transplant recipients.


RESULTS
VOD developed in four patients. They presented with extremely elevated levels of PAI-1 after BMT whereas tPA levels remained low. Additionally a transient decrease of protein S was found one week after BMT which was more pronounced in VOD patients. No protein C deficiency was observed.


CONCLUSIONS
Our data suggest that hypofibrinolysis due to an excess of PAI-1 may be involved in the pathogenesis of VOD. The determination of PAI-1 may be useful to recognize the development of VOD and facilitate the decision for thrombolytic therapy with rtPA. A decrease of protein S may play a role as a cofactor in the early phase after BMT.
Salat
C
C
Medizinische Klinik III, Klinikum Grosshadern, Ludwig-Maximilians-Universität München.
Holler
E
E
Reinhardt
B
B
Kolb
H J
HJ
Pihusch
R
R
Neumeister
P
P
Hiller
E
E
D016026:Bone Marrow Transplantation / Q000502:physiology*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006503:Hepatic Veins; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000628:therapy; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000134:cerebrospinal fluid; D013927:Thrombosis / Q000097:blood*
D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D017293:Protein S
Hyperkoagulabilität bei Patienten mit venookklusiver Erkrankung nach Knochenmarktransplantation.