Intravenous warfarin as an alternative for anticoagulation

Oral warfarin is the standard of care for patients requiring long-term anticoagulation due to venous thromboembolic disease. Patients with Crohn's disease may have reduced absorption in the small bowel due to loss of effective surface area secondary to chronic inflammation, ulcerative lesions, or resection. A 27-year-old Caucasian woman with end-stage Crohn's disease was hospitalized with an upper extremity thrombosis. In this complicated patient, who was resistant to oral warfarin and unable to receive subcutaneous low-molecular-weight heparin, therapeutic anticoagulation was achieved with intravenous warfarin. Intravenous warfarin provides an alternative administration route for patients who cannot receive the oral formulation and cannot be administered subcutaneous low-molecular-weight heparins due to adverse effects.