去纤苷(Defibrotide)副作用的处理措施？

During treatment with defibrotide, you should pay close attention to your own reactions and take corresponding measures in a timely manner to ensure drug safety and therapeutic effect.

Defibrinoside

is a heterogeneous mixture of polyanionic oligonucleotides currently approved for the treatment of transplant-related veno-occlusive disease. Although defibrotide has a known role in limiting endothelial cell activation, some studies have also shown anti-leukocyte properties.

Defibrotide side effects

The most common (incidence ≥10%) of Defibrotide are hypotension, diarrhea, vomiting, nausea and epistaxis, and the most common serious adverse reactions (incidence ≥5%) are hypotension and alveolar hemorrhage.

Treatment measures for side effects of Defibrotide

1. Hypotension: Pay attention to diet control. It is not advisable to eat too much at each meal. Add more protein-rich foods, such as lean meat, eggs, milk, etc., control emotions and avoid being overly excited. It is also necessary to appropriately strengthen exercise, improve physical fitness, and improve the regulatory functions of nerves and blood vessels.

2. Diarrhea: Diarrhea can cause a large amount of water and electrolyte loss. You need to drink more water during diarrhea to avoid dehydration. You can also choose oral rehydration salt solution. During diarrhea, you should pay attention to eating small and frequent meals and avoid eating large amounts. It is recommended to choose foods that are easy to digest, low-fat, and low-fiber, such as rice, bread, boiled vegetables, chicken, fish, etc., and avoid irritating foods, such as fried foods, spicy foods, and caffeine drinks.

If diarrhea symptoms are severe, over-the-counter antidiarrheal medications, such as montmorillonite powder, can be used to control symptoms. When using antidiarrheal drugs, you should pay attention to the dosage and duration of use, and it is best to use them under the guidance of a doctor.

3. Vomiting: When vomiting is obvious, you should temporarily fast, and then you can try to eat every 2-3 hours, or gradually increase your food intake after the vomiting symptoms subside.

Vomiting will cause the body to lose a lot of water and electrolytes, so it is necessary to replenish water. You can drink some warm water every 15-30 minutes to avoid stomach discomfort caused by drinking a large amount of water at one time. If vomiting symptoms persist, anti-emetic drugs, such as metoclopramide, can be used as directed by your doctor.

4. Nausea: Drinking warm water or lemonade can help relieve the symptoms of nausea. The water temperature should not be too cold or too hot to avoid irritating the stomach. At the same time, avoid drinking beverages containing caffeine, such as coffee, tea and cola, to avoid aggravating nausea.

When you feel nauseous, you need to adjust your diet to avoid excessively greasy, spicy, high-protein and other irritating foods. You can choose light, easy-to-digest, nutritious foods, such as porridge, noodles, vegetables, etc. At the same time, avoid overeating and chew carefully.

5. Nose bleeding: Compression is required to stop bleeding. Unilateral nose bleeding can compress the nose on the bleeding side, and bilateral nose bleeding can compress the nose on both sides, which can effectively control nose bleeding. You can also apply a cold towel on the bridge of the nose to shrink the capillaries in the nasal cavity and help stop bleeding. In addition, you can also take hemostatic drugs such as vitamin K1 tablets or ethylamine tablets under the guidance of a doctor for treatment.

6. Bleeding from other parts of the body: Defibrotide treatment should be stopped immediately, the underlying cause should be treated, and supportive treatment should be provided until the bleeding stops. Concomitant use of defibrotide and systemic anticoagulation or fibrinolytic therapy (not included for routine maintenance or reopening of central venous catheters) may increase the risk of bleeding.

Before treating fibrinolysis, discontinue anticoagulants and fibrinolytic agents and consider delaying initiation of dosing until the effects of the anticoagulants have diminished.

Defibrinated

Defibrotide is approved in the EU for the treatment of severe veno-occlusive disease/sinus obstructive syndrome (VOD/SOS) after hematopoietic cell transplantation in patients older than 1 month of age. The overall incidence of VOD/SOS with intravenous defibrotide is 5% in adult patients and 8% in pediatric patients.

In eight studies with data on intravenous defibrotide prophylaxis versus a control group (e.g., heparin, no prophylaxis), the incidence of VOD/SOS in the control group was 16%. Compared with the control group, the hazard ratio for VOD/SOS prevention with defibrotide was 0.30.

The incidence of VOD/SOS is lower after intravenous defibrotide prophylaxis, regardless of age group, and the relative risk of VOD/SOS with defibrotide prophylaxis is lower in patients at high risk for VOD/SOS.

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