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Warfarin Resistance and Enteral Feedings

Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio

Dave M. Lutomski, M.S.

Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio

Nutritional support via enteral feeding tubes may interfere with the response to medications by a number of mechanisms. A 31-year-old, white man was admitted after sustaining a gunshot wound to the chest and mandible. Subsequently, the patient developed pulmonary emboli documented by angiography. Attempts at anticoagulation with oral warfarin were unsuccessful while the patient was receiving 50-100 ml/ hr of Osmolite through an Entriflex feeding tube and intermittent oral Ensure Plus supplements. Discontinuation of the Osmolite resulted in a prompt prolongation of the prothrombin time. The Ensure Plus was continued and adequate prothrombin times were achieved on 7.5 to 10 mg of warfarin daily. The total amount of vitamin K received from the enteral feedings ranged from 50 to 115 µg/day, which is less than the normal daily intake of 300 to 500 µg. Previous reports of warfarin resistance implicated older enteral feeding products with a much higher vitamin K content. Difficulty with anticoagulation may still be experienced with the newer formulations. It is unknown whether the vitamin K content or malabsorption of warfarin is the mechanism of resistance. (Journal of Parenteral and Enteral Nutrition 13:206-208, 1989)

Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 2, 206-208 (1989)
DOI: 10.1177/0148607189013002206


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