What should I pay attention to during Defibrotide treatment?

Defibrotide is currently recognized as the most promising new drug for the treatment of hepatic veno-occlusive disease (HVOD) after hematopoietic stem cell transplantation (HSCT). Defibrotide has anticoagulant and fibrinolysis effects, and also promotes vascularization. Basic fibroblast growth factor (bFGF) has the effect of stimulating blood vessel formation. Some studies have found that defibrotide can not only combine with basic fibroblast growth factor (bFGF) to mobilize bFGF from the extracellular matrix, but can also protect bFGF from protease degradation, thereby stimulating angiogenesis.

The recommended dose of Defibrotide is 6.25 mg/kg given every 6 hours as a 2-hour intravenous infusion. Treatment lasts for a minimum of 21 days. If signs and symptoms of VOD do not resolve after 21 days, continue treatment until resolution. Defibrotide must be diluted before infusion. Do not coadminister Defibrotide with other intravenous medications at the same time and in the same intravenous line.

Defibrotide may enhance the pharmacodynamic activity of antithrombotic/fibrinolytic agents such as heparin or alteplase. Concomitant use of Defibrotide with antithrombotic or fibrinolytic drugs is contraindicated due to an increased risk of bleeding. Do not start Defibrotide in patients with active bleeding. Monitor patients for signs of bleeding. If a patient bleeds while taking Defibrotide, discontinue Defibrotide, treat the cause, and provide supportive care until bleeding has stopped.

Hypersensitivity reactions have occurred in less than 2% of patients treated with Defibrotide. These reactions include rash, urticaria, and angioedema. If a severe hypersensitivity reaction occurs, discontinue Defibrotide, treat with standard medical care, and monitor until symptoms resolve.

Clinical studies of Defibrotide in older adults did not include sufficient numbers of subjects aged 65 and older to determine whether they responded differently than younger subjects, and other reported clinical experience did not identify differences in responses between older and younger patients.