Barco et al reported thromboembolic and major bleeding events in patients receiving home parenteral nutrition. The authors are from Academic Medical Center Amsterdam and Johannes Gutenberg University in Mainz.

Thrombosis may include:

(1) vena cava syndrome

(2) pulmonary embolism


Risk factors for thrombosis associated with parenteral nutrition:

(1) prolonged use of the intravascular catheter

(2) high osmolarity of solutions

(3) limited mobility

(4) history of previous thrombosis

(5) cancer (active, ongoing chemotherapy, or recent diagnosis)

(6) failure to administer anticoagulation


A patient receiving anticoagulants was at increased risk of:

(1) bleeding

(2) heparin-associated complications (if heparin received), including HIT and hypersensitivity

(3) long-term administration problems for low-molecular weight heparins


Therapy with Vitamin K antagonists can be challenging, with uncertain oral absorption and the need to control vitamin K intake.

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