Risk of symptomatic central venous thrombotic complications in AIDS patients receiving home parenteral nutrition.
BACKGROUND
The acquired immunodeficiency syndrome (AIDS) is frequently complicated by malnutrition that may require parenteral nutritional support. In a non-AIDS population with long-term indwelling central venous catheters, low-dose warfarin therapy has been shown to prevent venous thrombosis. The purpose of this study was to determine the incidence of symptomatic central venous thrombosis in AIDS patients receiving home parenteral nutrition. The incidence of thrombosis on low-dose warfarin was compared with no prophylactic therapy.


METHODS
A retrospective review of 47 malnourished AIDS patients started on home parental nutrition was performed. None of the patients had a prior history of venous thrombosis. During this period, 9 of 47 patients were treated with low-dose warfarin therapy. The incidence of clinical and radiologic venous thrombosis was compared in these two groups.


RESULTS
Forty-seven patients were treated with parenteral nutrition for 296 patients-months. The rate of central venous thrombosis in patients receiving warfarin (0.016 thromboses per patient-month) was no different from those patients on no prophylactic therapy (0.009 thromboses per patient-month). The most common abnormality in coagulation observed in the entire group during follow-up was thrombocytopenia occurring in 66% of patients. Sixty percent of patients received medications that could interfere with platelet function.


CONCLUSIONS
We conclude that routine thrombosis prophylaxis with low-dose warfarin may not be justified in malnourished AIDS patients receiving home parenteral nutrition. Prospective clinical trials are needed to determine the risks and benefits of prophylactic warfarin therapy in this group of patients.
Duerksen
D R
DR
Department of Medicine, Deaconess Hospital, Boston, Massachusetts, USA.
Ahmad
A
A
Doweiko
J
J
Bistrian
B R
BR
Mascioli
E A
EA
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D008297:Male; D016562:Parenteral Nutrition, Home Total; D012189:Retrospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000209:etiology* / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D014859:Warfarin