Hepatic Veno-Occlusive Disease: A Role for Tissue Plasminogen Activator?

There are five published case reports of bone marrow transplantation (BMT) patients with hepatic veno-occlusive disease (VOD) who were treated with recombinant tissue plasminogen activator (rt-PA) and low-dose heparin. Two of the five patients had an initial response to rt-PA. One had complete resolution of clinical signs and symptoms. Bleeding occurred in three of the five. In a prospective, uncontrolled pilot study of seven allogeneic BMT patients, rt-PA was administered intravenously for two consecutive days, followed by low-dose heparin therapy. Five of the seven patients had a reduction in total bilirubin, and three of the five resolved their signs and symptoms of VOD. Adverse effects observed were limited to localized bleeding.