Warfarin Bioavailability With Feeding Tubes and Enteral Formula

Klang, Mark; Graham, Dennis; McLymont, V.

doi:10.1177/0148607109337257

Cited by 21 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fluctuations in INR due to warfarin binding to the enteral feeding or to protein supplementation were avoided by holding the enteral feeding for 1 hour prior to and after administration of warfarin 2 and liquid protein supplementation was scheduled to be administered separately from the warfarin administration time by at least 2 hours. Recent data suggest potential binding of warfarin to enteral feeding tubes 16 . However, this interaction did not likely contribute to this interaction as the patient consistently received warfarin via a feeding tube throughout the observational period.…”

Section: Discussionmentioning

confidence: 96%

Inadvertent Exaggerated Anticoagulation Following Use of Bismuth Subsalicylate in an Enterally Fed Patient Receiving Warfarin Therapy

2013

View full text Add to dashboard Cite

We report a case of an inadvertent increase in the international normalized ratio (INR) after the addition of bismuth subsalicylate for the treatment of diarrhea in an enterally fed patient receiving warfarin therapy. A 56-year-old Caucasian female presented to the trauma intensive care unit (ICU) with multiple lower extremity fractures. Warfarin was initiated for deep vein thrombosis prophylaxis due to the patient's inability to ambulate. The target INR was 2-3. Continuous intragastric enteral feeding was withheld 1 hour before and 1 hour after intragastric administration of warfarin. Bismuth subsalicylate 30 mL every 4 hours was prescribed for diarrhea. Within 3 days after starting bismuth subsalicylate therapy, the patient's INR increased from 2.56 to 3.54 and minor bleeding was noted from the patient's tracheostomy site. No significant change in warfarin dosage, variability in vitamin K intake, or medications that potentially alter warfarin metabolism were present during the unexpected rise in INR. When the bismuth subsalicylate was discontinued, the patient's INR stabilized into the target range on the same warfarin dose given at the time of the supratherapeutic INR. Salicylate displaces warfarin from plasma protein binding sites and may result in a significant increase in INR secondary to redistribution of warfarin to the free active form. Evaluation of this case report using the Drug Interaction Probability Scale and Naranjo Adverse Drug Reaction Probability Scale yielded scores consistent with a probable adverse drug interaction. Bismuth subsalicylate exaggerates warfarin's anticoagulant response and its concurrent use during warfarin therapy should be avoided.

show abstract

Section: Discussionmentioning

confidence: 96%

Inadvertent Exaggerated Anticoagulation Following Use of Bismuth Subsalicylate in an Enterally Fed Patient Receiving Warfarin Therapy

2013

View full text Add to dashboard Cite

show abstract

“…There had a great variation of Ka with a higher RSE (43.7%, 129.4%, 74.6% for PK models of warfarin, R- warfarin, and S- warfarin) meaning an incredible consequence about absorption. The bioavailability of warfarin is more than 95% ( Mark et al, 2010 ; Juno et al, 2013 ), some reports had applied 100% bioavailability when developing models ( Maria et al, 2003 ; Hamberg et al, 2007 ; Steven et al, 2011 ). Moreover, there were few reports to evaluate the absorption of warfarin due to its high bioavailability.…”

Section: Discussionmentioning

confidence: 99%

“…Structural PK model was fit to plasma concentrations, and typical values of absorption rate constant (Ka), apparent volume of distribution (V/F), and oral clearance (CL/F) were calculated (where F denotes bioavailability). In this study, each individual parameter was expressed approximately as a coefficient of variation to be a log-normal distribution with the mean of population parameters according to results of previous researches ( Maria et al, 2003 ; Eunice et al, 2010 ; Mark et al, 2010 ; Juno et al, 2013 ).…”

Section: Methodsmentioning

confidence: 99%

The Clinical Pharmacokinetics and Pharmacodynamics of Warfarin When Combined with Compound Danshen: A Case Study for Combined Treatment of Coronary Heart Diseases with Atrial Fibrillation

et al. 2017

View full text Add to dashboard Cite

Warfarin is used as anticoagulant and Compound Danshen prescription (CDP) is able to promote blood circulation. The combination might produce a synergic effect for patients of coronary heart diseases (CHDs) with atrial fibrillation (AF). Whether the combination increases the bleeding risk of warfarin is unclear, so the effects of Compound Danshen dripping pill (CDDP) on the pharmacokinetics (PK) and pharmacodynamics (PD) profiles of warfarin was investigated in patients. The dose and blood concentrations of warfarin, the four indicators of blood coagulation, prothrombin time, activated partial thromboplatin time, thrombin time, fibrinogen, and international normalized ratio value were compared when with and without CDDP treatment. The population PK (PPK) and PPK-PD models were established to assess patient demographics, genetic polymorphisms and CDDP as covariates. And the Seattle Angina Questionnaire was used to evaluate clinical efficacy, and the bleeding risk of combination was analyzed. The results indicated that CDDP had little influence on PK and PD profiles of warfarin in most patients and the combination of CCDP and warfarin would be a promising alternative regime for CHD with AF patients. The study was registered on China Clinical Trial Registry with number ChiCTR-ONRC-13003523.

show abstract

“…However, based on physician orders for the same product at the same rate starting 4 days prior to initiation, as well as the lack of physician orders for a long duration of NPO time during warfarin administration, as detailed in Table 2, it is possible but not likely that changing rates of enteral feeds alone caused the decrease in INR. In addition, warfarin resistance has been associated with enteral tube feedings and is thought to be due to warfarin either binding to the protein component of enteral nutrition (EN) products in a pH‐dependent manner or directly binding to feeding tubes 31 , 32 . While this interaction may have been present in this patient, it is unlikely to have caused the decrease in his INR, since the decrease occurred on the 10th day of warfarin administration after several weeks of receiving EN.…”

Section: Discussionmentioning

confidence: 99%

Probable Interaction Between Warfarin and Banana Flakes Supplement

King

Strnad

2015

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

Warfarin Bioavailability With Feeding Tubes and Enteral Formula

Abstract: Feeding-tube administration compromises the total amount of warfarin reaching patients. It appears, from this in vitro study, that the mechanism of the interaction of warfarin may be a result of direct binding to the feeding tube.

Cited by 21 publications

References 17 publications

Inadvertent Exaggerated Anticoagulation Following Use of Bismuth Subsalicylate in an Enterally Fed Patient Receiving Warfarin Therapy

Inadvertent Exaggerated Anticoagulation Following Use of Bismuth Subsalicylate in an Enterally Fed Patient Receiving Warfarin Therapy

The Clinical Pharmacokinetics and Pharmacodynamics of Warfarin When Combined with Compound Danshen: A Case Study for Combined Treatment of Coronary Heart Diseases with Atrial Fibrillation

Probable Interaction Between Warfarin and Banana Flakes Supplement

Contact Info

Product

Resources

About