Abstract
Admitted to hospital with an ischemic stroke, a 63-year-old male was diagnosed with a left ventricular mural thrombus. Enoxaparin treatment was started. Over 6 weeks there were two episodes of major hemorrhage needing brief discontinuation of anticoagulation. A previously normal prothrombin time (PT) became prolonged upon which vitamin K deficiency was diagnosed. The deficiency was caused by enteral feeding using a formula which did not contain the required daily dose of vitamin K. A triple message emerges from this observation: theneed for monitoring the PT in patients receiving enteral feeding, more so in those receiving anticoagulant along with enteral feeding, and the appeal to fortify feeding formulas with vitamin K.
Reference8 articles.
1. Antithrombotic therapy for patients with left ventricular mural thrombus;Lattuca;J Am Coll,2020
2. Menaka Pai. Laboratory Evaluation of Hemostatic and Thrombotic Disorders. In: Ronald Hoffman, Edward Benz, Helen Heslop, Jeffry Weitz, Hematology: Basic Principles and Practice, 7th edn, Elsevier. 2021;129:1922-1931.
3. Greenbaum LA. Vitamin K deficiency. In: Nelson Textbook of Pediatrics, Elsevier. 2020; 66:386-387.
4. Vitamin K-what is known regarding bariatric surgery patients: a systematic review;Sherf-Dagan;Surg Obes Relat Dis,2019
5. New Food and Drug Administration requirements for inclusion of vitamin K in adult parenteral multivitamins;J Helphingstine;JPEN J Parenter Enteral Nutr,2003