Hyperhomocysteinemia is associated with venous thrombosis in patients with short bowel syndrome.
BACKGROUND
Hyperhomocysteinemia is associated with venous thrombosis and vitamin deficiency. Patients with short bowel syndrome have increased risk of venous thrombosis due to central catheters, and of vitamin deficiency due to malabsorption. The current investigation was designed to evaluate the relationship between history of venous thrombosis and current hyperhomocystinemia and vitamin deficiency in patients with short bowel syndrome.


METHODS
Plasma total homocysteine (tHcy), serum vitamin B12, folate, B6, and methylmalonic acid (MMA) were measured. Venous thrombosis was documented by venogram or ultrasound.


RESULTS
Ten of 17 patients had venous thromboses, including 17 of 38 observed superior and 12 of 26 inferior veins. Total homocysteine was correlated with number of thromboses. The relative risk of multiple thromboses in the highest tHcy tertile was 3.6-fold that of the lowest tertile. Vitamin B12 and folate levels were within normal limits, but B12 deficiency by MMA or tHcy level was apparent in 7 patients. Vitamin-deficient patients had higher tHcy and MMA than those without deficiency.


CONCLUSIONS
Venous thrombosis in patients with short bowel syndrome is related to hyperhomocystinemia, which is also related to vitamin B12 deficiency, not detected by serum vitamin B12 concentration. Whether treatment of vitamin deficiencies and associated reduction in tHcy will reduce recurrent venous thrombosis in these patients is not known.
Compher
C W
CW
Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia 19104, USA. compherc@mail.med.upenn.edu
Kinosian
B P
BP
Evans-Stoner
N
N
Huzinec
J
J
Buzby
G P
GP
D000042:Absorption; D000328:Adult; D000368:Aged; D001361:Avitaminosis / Q000097:blood / Q000150:complications / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood; D008875:Middle Aged; D011736:Pyridoxine / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000097:blood / Q000150:complications* / Q000628:therapy; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000628:therapy
D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D011736:Pyridoxine