From the Research
Defibrotide can be administered regardless of platelet count, with no specific platelet threshold required for its use. For patients receiving defibrotide for veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), the standard dosing is 6.25 mg/kg intravenously every 6 hours (25 mg/kg/day) for a minimum of 21 days and until resolution of VOD/SOS symptoms, as supported by the most recent study 1. Unlike many other medications used in patients with hematologic conditions, defibrotide does not significantly increase bleeding risk despite its fibrinolytic properties, and therefore does not require platelet count monitoring or specific transfusion thresholds for administration. However, general platelet transfusion guidelines for patients with thrombocytopenia should still be followed (typically maintaining platelets >10,000/μL for stable patients or >20,000-50,000/μL for patients with active bleeding or requiring procedures) 2. Defibrotide works by protecting endothelial cells and restoring thrombo-fibrinolytic balance in the hepatic microvasculature, which is disrupted in VOD/SOS, rather than by directly affecting platelet function or coagulation factors.
Some key points to consider when administering defibrotide include:
- Early diagnosis and prompt treatment are crucial for optimizing outcomes in patients with VOD/SOS 1
- Defibrotide is the only approved treatment for SOS/VOD and should be administered within two days of diagnosis 1
- The standard dosing of defibrotide is 6.25 mg/kg intravenously every 6 hours (25 mg/kg/day) for a minimum of 21 days and until resolution of VOD/SOS symptoms 2
- General platelet transfusion guidelines for patients with thrombocytopenia should still be followed, even if defibrotide does not require specific platelet thresholds for administration 2
It's also important to note that while defibrotide has been shown to be effective in reducing mortality and improving outcomes in patients with VOD/SOS, it is not without potential risks and side effects, such as bleeding and hypotension 2. Therefore, careful monitoring and management of these potential complications is necessary when administering defibrotide.