Warfarin resistance associated with continuous enteral tube feedings was first reported in the early 1980s.1"5 This resistance was attributed to the large amounts of vitamin K contained within the feedings. It was not uncommon for patients to receive several hundred micro-grams per day of vitamin K from the feedings. The pharmaceutical industry subsequently responded to this problem by significantly reducing the vitamin K content of the liquid enteral nutrition formulations. However, despite these efforts with vitamin K content reduction, we still periodically experienced problems of achieving therapeutic anticoagulation when warfarin was given concomitantly with continuous liquid enteral feeding or experienced significant increases in the international normalized ratio (INR) for prothrom-bin time when the enteral feeding was discontinued.
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