47 - Young Investigator Meeting
Young Investigator Meeting
4. November 2022, 13:00 - 14:00, Gartensaal 2


Quality of warfarin anticoagulation in adults with short bowel syndrome on home parenteral nutrition
R. Fumagalli1, M. Szlaszynska1, M. Di Nisio2, S. Barco1, Presenter: R. Fumagalli1 (1Zürich, 2Chieti)

Patients with short bowel syndrome and nutritional deficiency necessitate long-term home parenteral nutrition (HPN). Thromboembolic complications in patients on HPN have an annual incidence of about 12%, whereas the prevalence is at least 50%. There is no firm evidence on optimal anticoagulation for HPN patients. Vitamin K antagonists (VKA) remain the most widely used drug class in this patient group. In light of the substantial paucity of data on quality of VKA anticoagulation in adults on HPN, its safety and effectiveness are uncertain.
This retrospective cohort study included adult patients on long-term HPN managed at a university hospital (2004-2015). HPN patients on warfarin therapy were matched based on sex, age, and indication for anticoagulation to controls also on warfarin. We compared time in therapeutic range (TTR) of therapeutic-dosed warfarin treatment (INR range 2.0-3.0) between the two groups and assessed thrombotic and bleeding events. Incidence rates of were calculated as number of events/100 patient-years. Ethical approval was obtained.
12 patients on HPN and 96 control patients were included. Median follow-up time was 48 (Q1–Q3: 23–89) months for HPN patients and 30 (Q1– Q3 19–43) months for controls. Overall, median TTR calculated over the entire follow-up period of warfarin anticoagulation was 62% (Q1–Q3: 47–73) in HPN patients and 68% (Q1–Q3: 55–78) in controls. The incidence of a composite of thromboembolic, major bleeding, and anticoagulation-related death events was similar in both groups with an incidence ratio of 0.9 (95% CI: 0.2–3.0) events per 100 patient-years. Only one patient from controls died for an intracerebral hemorrhage.
VKA anticoagulation can be adequately managed in HPN patients and is associated to a low rate of complications.
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