defibrotide and Pain

To provide a comprehensive review of hepatic sinusoidal obstruction syndrome (HSOS) in patients receiving a hematopoietic stem cell transplant and to describe the implications for nursing care.. Published research articles, reviews, case reports, and books.. Disagreement exists regarding the precise cause of HSOS. Prevention and treatment strategies have emerged based on these causative theories. Few published resources are available for nursing assessment and intervention specific to HSOS, although symptom management strategies derived from other disease etiologies can be used successfully.. HSOS is a complex consequence of myeloablative chemoradiotherapy. Although the overall incidence is declining, research continues to explore better methods for prophylaxis and develop more efficacious treatment options.. Nurses caring for patients receiving a hematopoietic stem cell transplant must comprehend the proposed etiologies for HSOS and be familiar with the manifestations of the syndrome. Symptom management requires a thorough understanding of affected organ systems.

Topics: Anticoagulants; Antifibrinolytic Agents; Antioxidants; Antithrombin III; Causality; Hematopoietic Stem Cell Transplantation; Hemofiltration; Hepatic Veno-Occlusive Disease; Hepatomegaly; Humans; Incidence; Jaundice; Nurse's Role; Nursing Assessment; Oncology Nursing; Pain; Patient Care Planning; Polydeoxyribonucleotides; Prognosis; Transplantation Conditioning; Ursodeoxycholic Acid

Eight patients with severe lower limb ischaemia, aged 65-80, received defibrotide intravenously for periods from 5 to 21 days (mean 13 days). All patients had intractable rest pain. Five had ischaemic ulcers and 3 had minor gangrene. Five had previous arterial surgery and 6 lumbar sympathetic ganglion injections. Pretreatment ankle pressure indices ranged from 0 to 0.5 (mean 0.19). Rest pain, sleep disturbance and analgesic requirement were assessed on a nominal scale. Rest pain improved in 4 and sleeping pattern in 2 patients. One patient showed a diminution in analgesic requirement. Pressure indices improved in 5 patients. Amputation was performed in 4 patients. Adverse reactions included vomiting and diarrhoea (2), thrombophlebitis at infusion site (3) and generalized skin reaction (1). All patients had 'end-stage' peripheral vascular disease but some showed symptomatic benefit. Further evaluation of defibrotide is indicated.

Topics: Aged; Amputation, Surgical; Blood Pressure; Diarrhea; Female; Fibrinolytic Agents; Humans; Ischemia; Leg; Male; Pain; Pain Management; Polydeoxyribonucleotides; Sleep; Vomiting