Hypocoagulation induced by broad-spectrum antibiotics in extensive burn patients

Abstract

Background Patients with extensive burns usually develop pro-coagulation soon after the injury if there is no sepsis occurred. We describe the case of an extensive burn adult suffering from hypocoagulation not related to sepsis, but secondary to antibiotic treatment. Case presentation Here, we report a case of an adult male patient suffering from flame burns of 45% total body surface area (40% full thickness) combined with inhalation injury. Hypocoagulopathy with soaring prolonged activated partial thromboplastin time value occurred on third week post-burn while systemic infection had been under control by application of broad-spectrum antibiotics. Investigations showed that not the infection but vitamin K-related coagulation factor deficiency were responsible for unexpected bleeding. However, supplemental vitamin K was not the key as we expected, which prompted us trying to decode the underlying cause of coagulation disturbance in this patient and pick out the most effective treatment for live-saving. After the withdrawal of highly suspected broad-spectrum antibiotic, Meropenem®, disturbed vitamin K related coagulation factors gradually restored to their optimal levels so as to maintain normal coagulation status. Therefore, surgical procedures without further risk of bleeding could be carried out in time for wound recovery. The patient was discharged on post-burn day 67 and transferred to a secondary hospital for his rehabilitation. Conclusion Hypocoagulopathy may be devoted to different reasons other than sepsis in extensive burns. Early recognition of the cause for coagulation disturbance is critical to make appropriate treatment and save patients’ lives. This case illustrated the importance of unveiling the mist cause for coagulation disturbance occurred in extensive burn patient, which paved the way for optimal life-saving treatments. And we also recommend burn surgeons to be alerted to antibiotic-induced vitamin K deficiency-related coagulopathy among critical burn patients.

Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature

“…Itagaki and Hagino published a case of a patient with haemorrhagic shock after thoracentesis, which was attributed to anatomic abnormality of the intercostal artery and hypovitaminosis K due to restricted diet and antibiotic therapy [ 10 ]. Vitamin K deficiency-associated hypocoagulation in a patient with extensive burns receiving meropenem was only reversed upon discontinuation of the broad-spectrum antibiotic therapy [ 11 ]. Nomoto et al reported a case of a patient with schizophrenia and catatonia who was hospitalised due to aspiration pneumonia and demonstrated low vitamin K levels and INR prolongation resulting from antibiotic therapy with ampicillin/sulbactam and cefmetazole as well as long-term restriction of food intake due to negativism and stupor [ 12 ].…”

Plant Kingdom as Source of Vitamins

“…• Reduced formation of gut microflora menaquinones, for instance during prolonged antibiotic therapy (Liu et al 2019), particularly when dietary supply cannot replace it, because of restricted diet (Itagaki and Hagino 2019) or in neonates (Aziz and Patil 2015). • Reduced intake in the context of vomiting, possibly observed in hyperemesis gravidarum (Baba et al 2016).…”

Signal Detection of Pediatric Drug–Induced Coagulopathy Using Routine Electronic Health Records

“…The prothrombin time (PT) or the activated partial thromboplastin time (APTT) is usually longer than the upper limits of normal ( Hiensch and Lee, 2021 ); therefore, DIC can often lead to abrupt and excessive bleeding complications and even death ( Hiensch and Lee, 2021 ). Early identification and timely correction of DIC in surgical patients or emergency department patients with significant bleeding are paramount to prevent death and other consequences of hemorrhage ( Liu et al, 2019 ). It has been reported that many kinds of medications, including vitamin K antagonists, direct oral anticoagulants, and antibiotics, could lead to DIC in the adult population ( Zengotita and Holt, 1986 ; Hall and Carson, 2012 ; Liu et al, 2019 ).…”

“…Early identification and timely correction of DIC in surgical patients or emergency department patients with significant bleeding are paramount to prevent death and other consequences of hemorrhage ( Liu et al, 2019 ). It has been reported that many kinds of medications, including vitamin K antagonists, direct oral anticoagulants, and antibiotics, could lead to DIC in the adult population ( Zengotita and Holt, 1986 ; Hall and Carson, 2012 ; Liu et al, 2019 ). However, the current pediatric drug safety landscape, including clinical trials, is limited as it rarely includes children and relies on extrapolation from adults.…”