INFLUENCE OF 2 DIFFERENT ESCHERICHIA-COLI ASPARAGINASE PREPARATIONS ON COAGULATION AND FIBRINOLYSIS - A RANDOMIZED TRIAL

Hypercoagulability and thrombosis are well documented side effects of leukemia treatment with l-asparaginase (I-asp). To determine haemostatic alterations of different E.coli asp preparations a randomized prospective study was carried out in 20 leukemic children (ALL-BFM 90): 10 patients received l-asp Crasnitin(R)/Bayer AG (group A) and 10 patients Medac(R) (group B). Blood samples for coagulation studies were obtained prior and whilst medication. L-asp activities were higher in group B, leading to prolonged asn and gin depletion and longer inhibition of hepatic protein synthesis. Alterations of haemostatic parameters observed were more pronounced in group B: values of P-Fibrinogen, P-Antithrombin, P-Plasminogen and P-Plasmin inhibitor were significantly decreased and P-Fibrin D-dimers were found to be clearly higher than in group A. Changes of P-VWF and P-Plasminogen activator inhibitor 1, the latter only enhanced at one time point in group B, did not differ in both groups. In group B a 13 year old boy developed thrombosis and a 7 year old girl acquired type I diabetes mellitus.