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Hyperhomocysteinemia Is Associated with Venous Thrombosis in Patients with Short Bowel Syndrome

Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, compherc{at}mail.med.upenn.edu

Bruce P. Kinosian, MD

Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania

Nancy Evans-Stoner, MSN, RN

Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania

Jill Huzinec, RPh

Penn Home Infusion Therapy, University of Pennsylvania Health System, Philadelphia, Pennsylvania

Gordon P. Buzby, MD

Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania

Background: Hyperhomocysteinemia is associated with venous thrombosis and vitamin deficiency. Patients with short bowel syndrome have increased risk of venous thrombosis due to central catheters, and of vitamin deficiency due to malabsorption. The current investigation was designed to evaluate the relationship between history of venous thrombosis and current hyperhomocystinemia and vitamin deficiency in patients with short bowel syndrome. Methods: Plasma total homocysteine (tHcy), serum vitamin B₁₂, folate, B₆, and methylmalonic acid (MMA) were measured. Venous thrombosis was documented by venogram or ultrasound. Results: Ten of 17 patients had venous thromboses, including 17 of 38 observed superior and 12 of 26 inferior veins. Total homocysteine was correlated with number of thromboses. The relative risk of multiple thromboses in the highest tHcy tertile was 3.6-fold that of the lowest tertile. Vitamin B₁₂ and folate levels were within normal limits, but B₁₂ deficiency by MMA or tHcy level was apparent in 7 patients. Vitamin-deficient patients had higher tHcy and MMA than those without deficiency. Conclusions: Venous thrombosis in patients with short bowel syndrome is related to hyperhomocystinemia, which is also related to vitamin B₁₂ deficiency, not detected by serum vitamin B₁₂ concentration. Whether treatment of vitamin deficiencies and associated reduction in tHcy will reduce recurrent venous thrombosis in these patients is not known. (Journal of Parenteral and Enteral Nutrition 25:1-8, 2001)

Journal of Parenteral and Enteral Nutrition, Vol. 25, No. 1, 1-8 (2001)
DOI: 10.1177/014860710102500101


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