Anorexia Nervosa

The use of thrombelastography to determine coagulation status in severe anorexia nervosa: a case series

International Journal of Eating Disorders
By Philip S. Mehler, MD, FACP, FAED, CEDS


Objective: Hospitalized patients with severe anorexia nervosa (AN) frequently have a complex coagulation profile, with elements of hypocoagulability--thrombocytopenia and elevated international normalized ratio (INR) and elements of hypercoagulability--usually manifested as immobility, which is either due to their marked weakness or from enforced degrees of bed rest to minimize energy expenditure. Hospitalized medical patients have been shown to have appropriate prophylaxis for venous thromboembolic (VTE) disease in only 40% of cases.

Method: A simple test that could evaluate the overall coagulation profile of these patients would help guide appropriate VTE prophylaxis. The thrombelastogram is a blood test that evaluates the full dynamic process of hemostasis.

Results: The study of patients did not reveal evidence of being hypocoagulable and thus should be considered for VTE prophylaxis.

Discussion: We report on three cases of young women with severe AN and weakness, hospitalized for closely monitored refeeding, in whom the thromboelastogram was used to evaluate the coagulation status of the patient and assist in guiding therapy.

Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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