Oral anticoagulation in patients with short-bowel syndrome

DICP : the Annals of Pharmacotherapy
J P OwensC C Murphy

Abstract

A 55-year-old woman was transferred to our institution from another hospital. The history of her present illness began 17 days earlier with a right-sided cerebral vascular accident (CVA). Three days later she had a superior mesenteric artery (SMA) embolus with infarcted bowel. Her small bowel was resected leaving about 20-25 centimeters of small bowel. A cardiac echo on hospital day 6 documented the presence of a left ventricular embolus, which was considered to be the cause of her CVA and SMA embolus. The cardiologists recommended lifelong anticoagulation, preferably with warfarin when technically feasible. After one month of warfarin therapy, with doses as high as 25 mg/d, the patient's prothrombin times (PTs) were not changed from baseline; however, this was probably due to concomitant therapy with vitamin K. Heparin was incorporated into her total parenteral nutrition (TPN) in preparation for her discharge. Because the TPN was cycled, she required subcutaneous heparin twice daily while off TPN. This patient's clinical course while she was maintained on heparin therapy was complicated by bleeding episodes and extensive thigh and abdominal hematomas, which led to erratic heparin absorption and widely fluctuating partial throm...Continue Reading

References

Jan 1, 1987·JPEN. Journal of Parenteral and Enteral Nutrition·Z Gimmon
May 1, 1987·JPEN. Journal of Parenteral and Enteral Nutrition·D M LutomskiR H Bower
Jan 1, 1986·JPEN. Journal of Parenteral and Enteral Nutrition·P J Kearns, R A O'Reilly
Apr 1, 1980·Thrombosis Research·P G BentleyN Jones

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Citations

Feb 14, 2006·Journal of Thrombosis and Thrombolysis·Alex C Spyropoulos
Aug 28, 2009·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Brian J SabolCharles E Wilkins
Jan 14, 2005·Journal of Clinical Pharmacology·David J Greenblatt, Lisa L von Moltke
May 23, 2020·Digestive Diseases and Sciences·Alice HuangJohn Kerner

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