<strong>Indian</strong> J. Pharm. Pract. 1(2), Jan-Mar, 2009CONCLUSIONL-asparaginase studies <strong>of</strong> fibrinogen survival usingTreatment related to thrombotic complications during autologus 1-131fibrinogen. Blood 1970; 35:195-the induction therapy and recent evidence indicates that 200.concomitant administration <strong>of</strong> L-asparaginase is likely 8. Peterson RC, Handschumacher RF, Mitchell MS.to be associated with higher incidence <strong>of</strong> central venous Immunological responses to Lasparaginase. J Clinthrombosis, especially in children with atleast one Invest 1971; 50:1080-1090.prothrombotic risk factor. This result in prolongation <strong>of</strong> 9. Gugliotta L, Augelo A, Mattioli-Belmonte M,the prothrombin time (PT), activated partial Vigano-O'Angelo S, Colombo G, Catoni L, et al.thromboplastin time (aPTT) and hyp<strong>of</strong>ibrinogenimia. Hypercoagulability during L-asparaginaseThese coagulation abnormalities resolve within 1-2 treatment the effect <strong>of</strong> antithrombin IIIweeks after cessation <strong>of</strong> the drug.supplemantation in vivo. Br J Haematol 1990; 74At present, there is no general agreement on the need to (4):465-470.monitor the coagulation/fibrinolytic systems in patients 10. Kingma A, Tammnga RY, Kamps WA, Le-ceultre R,treated with L-asparaginase. There are also no Saan RJ. Cerebrovascular complications <strong>of</strong>guidelines on ways to avoid either the haemorrhagic or L-asparaginase therapy in children with leukemia:the thrombotic complications. It is suggested to replace aphasia andother neuropsychological deficits.the coagulation factors with fresh frozen plasma and at Pediatr Hematol Onco1 1990; 10(4):303-309.the same time, give AT III and heparin; but the 11. AI-Mondhiry H. Hyp<strong>of</strong>ibrinogenemia associatedconsensus is to treat expectantly.with vincristine and prednisone therapy inACKNOWLEDGMENT lymphoblastic leukemia. Cancer 1975; 35:144-147The authors are thankful to Dr.Nalla G Palaniswami, 12. Ramsay NKC, Coccia PF, Krivit W, Nesbit ME,Chairman and Managing Director <strong>of</strong> Kovai Medical Edson JR. The effect <strong>of</strong> Lasparaginase on plasmaCenter and Hospital, Coimbatore and Dr.Thavamani D coagulation in acute lymphoblastic leukemia.Palaniswami, Trustee, Kovai Medical Center ResearchCancer 1977; 40:1398-1401.and Educational Trust, Coimbatore for providing 13. Kucuk 0, Kwaan HC, Gunnar W, Vazguez M.necessary facilities and continuous encouragement. Thromboembolic complications associated with L-REFERENCESasparaginase therapy. Cancer 1985; 55:702-706.1. Redaelli A, Laskin BL, Stephens JM, Botteman14. Priest JR, Ramsay NKC, Latcham RE, Lockman LA,MF, Pashos CL. A systematic literature review <strong>of</strong>Hasegawa DK, Coetes TD. Thrombotic andthe clinical and epidemiological burden <strong>of</strong> acutehemorrhagic strokes complicating early therapy forlymphoblastic leukaemia. Europ J Cancer Carechildhood acute lymphoblastic leukemia. Cancer2005; 14:53-62.1980; 46:1548-1554.2. Athale UH, Chan AKC. Thrombosis in children15. Priest JR, Ramsay NKC, Stemtarz PG, Tubergen DG,with acute lymphoblastic leukaemia:Cairo MS, Sitarz AL, etal. A syndrome <strong>of</strong> thrombosisepidemiology <strong>of</strong> thrombosis in children with acuteand hemorrhage complicating L-asparaginaselymphoblastic leukaemia. Thrombosis Res 2003;therapy for childhood acute lymphoblastic111:125-131.3. Capizzi RL, Bertmo JR, Handschumacher RE.leukemia. J Pediatr 1982; 100:984-989.16. Cairo MS, Lazarus K, Gilmare RL, Bachrur RL.L-asparaginase. Ann Rev Med 1970; 21:433.4. Keating MJ, Holmes R, Levuar S, Ho OH.Intracranial hemorrhage and focal seizuresL-asparaginase and PEG asparaginase past,secondary to use <strong>of</strong> L-asparaginase during inductionpresent, and future. Leuk lymphoma 1993; 10:153-therapy <strong>of</strong> acute lymphocytic leukemia. J Pediatr157.1980; 97:829-833.5. Haskell CM, Canellos GP, Leventhal BG, Carbore 17. Parma M, Belotti D, Pogliani-EM. Management <strong>of</strong>PP, Block JP, Serpick AA, et al. L-asparaginase L-asparaginase induced prothrombotic state in acutetherapuetic and toxic effect in patient with lymphoblastic leukemia. Haematologica 1996;neoplastic disease. N Engl J Med 1969; 281:1028- 81(2):191.18. Celeste Lindley. Adverse effects <strong>of</strong> chemotherapy.1034.6. Oettgen HF, Stephanson PA, Schwatz ML, Leopar In: Koda-Kimble Mary Anne , Yee Young Lloyd ,RO, Fallal KR, Tan CC. Toxicity <strong>of</strong> Ecoli Kradjan Wayne A, Guglielmo Joseph B, AlldredgeL-asparaginase in man. Cancer 1970;25:153-278.Brian K, Corelli Robin L. Applied therapeutics: The7. Peterson RE, Himelstein ES, Oettgen HF and clinical use <strong>of</strong> drugs. Philadelphia: 2005; LippincottClifford GO. Hyp<strong>of</strong>ibrinogenemia due to Will ia ms & Wi lk ins:89- 95.84
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