Choline Deficiency Is Associated With Increased Risk for Venous Catheter Thrombosis

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Abstract
Background: Patients with intestinal failure who require long‐term parenteral nutrition (PN) develop catheter thrombosis as a complication. This patient group may also develop choline deficiency because of a defect in the hepatic transsulfuration pathway in the setting of malabsorption. This study was undertaken to determine whether choline deficiency is a risk factor for development of catheter thrombosis. Methods: Plasma free and phospholipid‐bound choline concentrations were measured in a group of 41 patients that required long‐term PN. Episodes of catheter thrombosis from onset of PN to the time of blood testing were recorded. Results: Sixteen (39%) patients developed catheter thrombosis, and 5 of these had recurrent catheter thrombosis. Plasma free choline was 7.7 ± 2.7 nmol/mL in patients with no history of catheter thrombosis and 6.2 ± 1.7 nmol/mL in patients with previous catheter thrombosis (p = .076 by Wilcoxon rank‐sum test). The partial correlation between plasma free choline concentration and the frequency of clots after controlling for catheter duration was r = –0.33 (p = .038). The relative risk for catheter thrombosis in subjects with a plasma free choline concentration p = NS). Conclusion: Choline deficiency is a significant risk factor for development of catheter thrombosis in patients with intestinal failure who require PN.

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