WARFARIN AND REDUCED CENTRAL VENOUS THROMBOSIS IN-HOME TOTAL PARENTERAL-NUTRITION PATIENTS

Central venous thrombosis is a potentially life-threatening complicati on in patients on long-term home total parenteral nutrition (HTPN). La ck of venous access due to recurrent thromboses can prevent delivery o f life-saving nutritional support. The long-term anticoagulation manag ement to prevent thromboses in patients with central venous catheters for HTPN has not been well established. We have reviewed the role of w arfarin in reducing the incidence of thromboses and its safety in our HTPN patients. Ninety consecutive HTPN patients were studied retrospec tively. Twenty-two thromboses occurred during 1312 patient-mo in 53 HT PN patients on minidose warfarin. A minidose of warfarin is defined as 1-2 mg and does not prolong the prothrombin time. Seven thromboses oc curred over 619 mo in 18 patients on a therapeutic dose of warfarin (m inidose compared to therapeutic dose, p>0.05). A therapeutic dose of w arfarin is a dose that increases the prothrombin time to 1.2-1.5 times that of control. Twelve patients who had 18 thromboses in 323 patient -mo while on minidose warfarin were subsequently converted to therapeu tic warfarin. The incidence of thromboses decreased to 2 in 369 patien t-mo (p<0.005). There were no hemorrhagic complications in the minidos e warfarin group and four nonfatal hemorrhagic complications in the th erapeutic dose warfarin group (p>0.05). A therapeutic dose of warfarin is effective in reducing the incidence of thromboses in patients who experience central venous thrombosis despite minidose warfarin with a minimal increase in hemorrhagic complications.