A Review of Tissue Plasminogen Activator in the Treatment of Veno‐Occlusive Liver Disease after Bone Marrow Transplantation

Abstract

Veno‐occlusive disease (VOD) of the liver is a potentially life‐threatening complication that usually occurs secondary to high dose‐chemotherapy with or without total body irradiation as preparative therapy for bone marrow transplantation. The key event in the development of VOD is damage to the vascular endothelium in the liver, which produces a hypercoagulable state triggering the clotting cascade. Factor VIII and fibrinogen are deposited in the hepatic venules, leading to obliteration of the venules. Tissue plasminogen activator (t‐PA) converts fibrin‐bound plasminogen to plasmin, thereby producing clot lysis. Review of the literature suggests that t‐PA can be administered safely, with some limitations, for the treatment of VOD. (Pharmacotherapy 1997;17(5):929–937)