Low molecular weight heparin in the treatment of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome: five case reports.

Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by the intake of pyrrolizidine alkaloids (PAs). The disease has a high mortality rate, a poor prognosis and limited treatment options. Managing pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a significant challenge for hepatologists. This case report describes five patients with PA-HSOS that were treated with low molecular weight heparin (LMWH) between 2014 and 2019. All five patients had a history of taking PA-containing herbal preparations before the onset of the disease. They all met the Nanjing diagnostic criteria and were diagnosed with PA-HSOS. Symptomatic treatment was administered to all five patients. In addition to symptomatic treatment, all five patients were treated with LMWH for approximately 8-21 days. After treatment, their ascites disappeared, symptoms improved and the hepatic venous blood flow had improved compared with before treatment. There was no obvious discomfort during the 6 months of follow-up. LMWH may play a useful role in the early treatment of PA-HSOS. Therefore, for patients in the early stages of PA-HSOS, in addition to symptomatic treatment, early anticoagulant intervention can be attempted to improve patient prognosis under close monitoring of coagulation.