title: Warfarin resistance in a patient with short bowel syndrome.
abstract: Drug therapy in short bowel syndrome can be complicated by inadequate or incomplete absorption of drugs in the small intestine. Many case reports claim that warfarin absorption is not affected by the syndrome. We treated a patient with oral warfarin for recurring deep vein thrombosis; up to 20 mg/day was administered with no increase in the international normalized ratio. Drug-drug interactions that may prevent absorption, increase metabolism, or antagonize the effects of warfarin were ruled out. Intravenous lipid administration, which is anecdotally reported to precipitate warfarin resistance, may have contributed to the condition, but dosing was less frequent than in published reports. The most probable explanation of warfarin resistance is the reduced surface area for drug absorption secondary to surgical removal of the patient's duodenum and gastrojejunostomy.
authors.affiliation: Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond 23298-0533, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Brophy
authors.forename: S L
authors.initials: SL
authors.lastname: Ford
authors.forename: M A
authors.initials: MA
authors.lastname: Crouch
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000378:metabolism / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D019934:International Normalized Ratio; D007408:Intestinal Absorption; D008297:Male; D012008:Recurrence; D012778:Short Bowel Syndrome / Q000150:complications*; D013924:Thrombophlebitis / Q000150:complications / Q000517:prevention & control*; D014859:Warfarin / Q000378:metabolism / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin