Central venous thrombosis in patients receiving long-term parenteral nutrition.
Long-term parenteral nutrition (PN) is administered to patients who are unable to use their gastrointestinal tract to absorb sufficient nutrients and water to maintain their nutritional status. Patients receiving long-term parenteral nutrition are at risk of numerous complications including thrombosis of the central venous catheter used to provide nutrition. Central venous access is essential to the successful delivery of long-term PN. One of the strategies to lessen the frequency of this complication is anticoagulation therapy with warfarin. The effect of warfarin in preventing this complication may be modified by vitamin K intake. Individuals with gastrointestinal failure may receive vitamin K from a variety of sources. This review summarizes the role of warfarin in preventing central venous access thrombosis. It also summarizes potential sources of vitamin K intake in home parenteral nutrition patients, examines the evidence for recommendations regarding vitamin K intake, and considers the potential impact of increased vitamin K intake on home PN patients, particularly on the prevention of central venous thrombosis.
Duerksen
Donald R
DR
Department of Medicine, University of Manitoba, and Division of Gastroenterology, St. Boniface Hospital, C5120 409 Tache Ave., Winnipeg, MB R2H 2A6. duerksn@cc.umanitoba.ca
D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000178:diet therapy*; D006801:Humans; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D013997:Time Factors; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014812:Vitamin K; D014859:Warfarin