Warfarin therapy in children who require long-term total parenteral nutrition

Pediatrics. 2003 Nov;112(5):e386. doi: 10.1542/peds.112.5.e386.


Objective: To determine whether warfarin can be safely administered to children who require long-term total parenteral nutrition (TPN), for the purpose of preventing central venous access device (CVAD)-related thrombosis.

Methods: A prospective cohort study was conducted of 8 children with short-gut syndrome or small intestinal anomalies. All patients received oral anticoagulant therapy (warfarin) managed by the hematology department at a tertiary pediatric center. Data collected included demographic details, nutritional intake, age, weight, history of deep vein thrombosis, number and functional duration of CVADs, warfarin requirements, and adverse event rates.

Results: A total of 15.2 warfarin years were studied prospectively. The target therapeutic range was achieved 51.1% of time. The mean dose of warfarin required to achieve the target therapeutic range (international normalized ratio) of 2.0 to 3.0 was 0.33 mg/kg/d. The mean duration between warfarin monitoring tests was 6.6 days. The median vitamin K intake per patient was 0.367 mg/kg/d (range: 0.018-2.85 mg/kg/d). Before commencing anticoagulant therapy, the mean CVAD duration was 160.9 days. Concomitant warfarin therapy was associated with a mean CVAD duration of 351.7 days. There were no major bleeding events, and no clinical extension of thrombosis was observed.

Conclusions: This is the first published study to report uniform warfarin prophylaxis for CVADs in children. Warfarin therapy can be administered safely in children who require long-term TPN. Warfarin prophylaxis seems to prolong CVAD survival.

MeSH terms

  • Adolescent
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Catheterization, Central Venous / adverse effects
  • Child
  • Child, Preschool
  • Cohort Studies
  • Congenital Abnormalities / therapy
  • Drug Evaluation
  • Female
  • Hemorrhage / chemically induced
  • Humans
  • International Normalized Ratio
  • Intestine, Small / abnormalities
  • Male
  • Parenteral Nutrition, Total*
  • Prospective Studies
  • Safety
  • Short Bowel Syndrome / therapy
  • Thrombosis / etiology
  • Thrombosis / prevention & control
  • Vitamin K / administration & dosage
  • Warfarin / adverse effects
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Vitamin K
  • Warfarin