Cefazolin and Coagulation Disorder: A case report and review of literature

Abstract

A 63-year old Yemeni male, known case of endstage renal disease (ESRD), hypertension and diabetes mellitus, underwent craniotomy and endoscopic removal of an intraventricular mass. Peri-operatively he was started on cefazolin, a normal diet and regular hemodialysis without heparin. The international normalising ratio (INR) increased rapidly, reaching 4.2 on day five but responded equally rapidly to parenteral Vitamin K and withdrawal of cefazolin. Cefazolin is an antibiotic commonly used in clinical practice because of its long half-life, narrow spectrum and its ability for dose adjustment in renal failure patients. We review the literature, discuss the risk factors of its use and suggest possible mechanisms causing the prolonged coagulation.

Deranged Coagulation Profile Secondary to Cefazolin Use: Case Report

“…In prior case reports, cefazolin use has been demonstrated to induce vitamin-K-deficient coagulopathy [ 1 , 2 , 3 , 4 , 5 , 6 ]. Although more commonly associated with ticarcillin and nitrofurantoin, this remained a less well-known complication of cefazolin [ 1 ].…”

“…While the underlying mechanism was not fully understood, several mechanisms have been proposed. It may be the result of altered intestinal flora due to the antimicrobial effect of cefazolin, which is the main source of vitamin K [ 2 ]. Alternatively, the cephalosporin itself may exert a direct effect in suppressing synthesis of vitamin K by the liver [ 2 , 3 ].…”

“…It may be the result of altered intestinal flora due to the antimicrobial effect of cefazolin, which is the main source of vitamin K [ 2 ]. Alternatively, the cephalosporin itself may exert a direct effect in suppressing synthesis of vitamin K by the liver [ 2 , 3 ]. Structurally, cefazolin contains the methyl-thiadiazole side chain that appeared to exert similar effects to vitamin K epoxide reductase inhibitors.…”

“…Cefazolin is a widely used first-generation cephalosporin. While generally well tolerated, several case reports have described severe coagulopathy induced by intravenous (IV) cefazolin [ 1 , 2 ]. Particularly in patients with impaired renal function, antibiotic choice is limited and may require specific dose adjustments.…”

“…Particularly in patients with impaired renal function, antibiotic choice is limited and may require specific dose adjustments. Altered renal handling of antibiotics and their metabolites may potentiate toxicity and side effects [ 1 , 2 , 3 ].…”