Sinusoidal obstruction syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The management of sinusoidal obstruction syndrome depends on the severity of the disease. However, supportive care is the mainstay of therapy for mild and moderate sinusoidal obstruction syndrome. The severe case need defibrotide (thrombolytic agent) along with supportive care. Patients are advised to avoid supplements and medications that are linked to hepatic injury.

Medical Therapy

• The management of sinusoidal obstruction syndrome depends on the severity of the disease.
• Supportive care is the mainstay of treatment.
• Supportive measures include:
  • Maintaining intravascular volume
  • Avoidance of hepatotoxic agents
  • Paracentesis can be done to remove ascitic fluid
  • Narcotics can be used to keep patient pain free.
• Patients with mild to moderate sinusoidal obstruction syndrome can be treated with supportive care alone. However, severe cases need defibrotide (thrombolytic agent) along with supportive care.

Parameters	Mild	Moderate	Severe
Serum total bilirubin	<5 mg/dL	< (5.1 to 8 mg/dL	>8 mg/dL
Serum aspartate aminotransferase (AST)	<3 x normal	3 to 8 x normal	>8 x normal
Weight above baseline	<2 percent	2 to 5 percent	>5 percent
Serum creatinine	Normal	<2 x normal	>2 x normal