title: [A patient with lessened sensitivity to acenocoumarol during a period of enteral feeding].
abstract: A 69-year-old man was operated on for a subdural haematoma which had developed during the use of acenocoumarol. Directly after the operation the patient was started on enteral feeding. The acenocoumarol was restarted at a later stage. The dose of acenocoumarol needed for an appropriate level of blood-dilution was twice as high during the period of enteral feeding than it had been preoperatively. After the transition from enteral feeding to oral feeding it was possible to lower the dose of acenocoumarol. The need for a higher dose was probably due to enhanced binding of the proteins in the enteral feeding. The patient was admitted to a nursing home. The combination of acenocoumarol and enteral feeding occurs frequently in patients being rehabilitated. It is important to monitor the blood-dilution when starting and stopping enteral feeding.
authors.affiliation: Kenniscentrum Geriatrie, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB, Nijmegen.
authors.forename: M D
authors.initials: MD
authors.lastname: van Iersel
authors.forename: A A
authors.initials: AA
authors.lastname: Blenke
authors.forename: H P
authors.initials: HP
authors.lastname: Kremer
authors.forename: Y A
authors.initials: YA
authors.lastname: Hekster
mesh_terms: D000074:Acenocoumarol / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000368:Aged; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005526:Food, Formulated / Q000009:adverse effects*; D018565:Food-Drug Interactions; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008991:Monitoring, Physiologic; D011485:Protein Binding
chemical_list: D000925:Anticoagulants; D000074:Acenocoumarol