The prevalence of coagulation abnormalities in hospitalized patients receiving lipid-based parenteral nutrition.
BACKGROUND
Vitamin K is not a component of the multivitamin preparation added to parenteral nutrition (PN) solutions, and hospitalized patients receiving parenteral nutrition support are at risk of developing vitamin K deficiency.


METHODS
In this study, 84 consecutive patients receiving PN were followed up prospectively to determine the incidence of a raised international normalized ratio (INR). All patients received lipid in their PN, which contains approximately 30 microg of vitamin K/100 mL.


RESULTS
Patients were followed up for the course of PN or up to 4 weeks if they needed longer total parenteral nutrition. A raised INR compared with baseline developed in 3.6% of patients. All elevations were mild, and no patients developed clinical bleeding.


CONCLUSIONS
It may be unnecessary to routinely supplement patients with vitamin K if they are receiving a lipid emulsion containing significant amounts of vitamin K. For patients receiving warfarin therapy, it will be important for nutrition support services to be aware of the vitamin K content of the lipid emulsion they are using as patients receiving a multivitamin preparation containing vitamin K and lipid emulsion may receive increased amounts of vitamin K, which could lead to warfarin resistance.
Duerksen
Donald R
DR
Department of Medicine, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. duerksn@cc.umanitoba.ca
Papineau
Noreen
N
D000368:Aged; D001778:Blood Coagulation Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005217:Fat Emulsions, Intravenous; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects; D011446:Prospective Studies; D014812:Vitamin K / Q000008:administration & dosage; D014813:Vitamin K Deficiency / Q000453:epidemiology
D005217:Fat Emulsions, Intravenous; D014812:Vitamin K