Case Reports
21 November 2023
Vol. 17 No. 3 (2023)
Prolonged prothrombin time in a rare case of vitamin K deficiency: a case report and a narrative review
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Prolonged prothrombin time increases the risk of bleeding complications in proportion to prolongation severity. We reported the case of a 72-year-old woman with a recent hospitalization for methicillin-susceptible Staphylococcus aureus endocarditis complicated by spondylodiscitis who developed a severe prolongation of clotting time during treatment with cefazolin due to a vitamin K deficiency. Cefazolin is a first-generation cephalosporin active against gram-positive bacteria. Like other cephalosporins, it is potentially able to inhibit the enzymes involved in recycling vitamin K metabolites, leading to a fall in gamma-carboxylation of vitamin K-dependent clotting factors. Clinicians should be aware of the necessity of regular monitoring of clotting times for the duration of antimicrobial therapy, especially in those patients with several risk factors for a poor vitamin K nutritional status. Prompt detection of vitamin K deficiency should be recognized and adequately supplemented.
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Marchili MR, Santoro E, Marchesi A, et al. Vitamin K deficiency: a case report and review of current guidelines. Ital J Pediatr 2018;44:36. DOI: https://doi.org/10.1186/s13052-018-0474-0
Araki S, Shirahata A. Vitamin K Deficiency Bleeding in Infancy. Nutrients 2020;12. DOI: https://doi.org/10.3390/nu12030780
Mijares ME, Nagy E, Guerrero B, Arocha-Piñango CL. Vitamin K: biochemistry, function, and deficiency. Review. Invest Clin 1998;39:213-29.
Halder M, Petsophonsakul P, Akbulut AC, et al. Vitamin K: Double Bonds beyond Coagulation Insights into Differences between Vitamin K1 and K2 in Health and Disease. Int J Mol Sci 2019;2. DOI: https://doi.org/10.3390/ijms20040896
Mackie IJ, Walshe K, Cohen H, et al. Effects of N-methylthiotetrazole cephalosporin on haemostasis in patients with reduced serum vitamin K1 concentrations. J Clin Pathol 1986;39:1245-9. DOI: https://doi.org/10.1136/jcp.39.11.1245
Angles E, Mouton C, Perino J, et al. Hypoprothrombinemia and severe perioperative haemorrhagic complications in cardiac surgery patients treated with high-dose cefazolin for infective endocarditis. Anaesth Crit Care Pain Med 2018;37:167-70. DOI: https://doi.org/10.1016/j.accpm.2017.07.006
Agnelli G, Del Favero A, Parise P, et al. Cephalosporininduced hypoprothrombinemia: is the N-methylthiotetrazole side chain the culprit? Antimicrob Agents Chemother 1986;29:1108-9. DOI: https://doi.org/10.1128/AAC.29.6.1108
Lin X, Kück U. Cephalosporins as key lead generation beta-lactam antibiotics. Appl Microbiol Biotechnol 2022;106:8007-20. DOI: https://doi.org/10.1007/s00253-022-12272-8
Park GH, Kim S, Kim MS, et al. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2019;16. DOI: https://doi.org/10.3390/ijerph16203937
Shearer MJ, Bechtold H, Andrassy K, et al. Mechanism of cephalosporin-induced hypoprothrombinemia: relation to cephalosporin side chain, vitamin K metabolism, and vitamin K status. J Clin Pharmacol 1988;28:88-95. DOI: https://doi.org/10.1002/j.1552-4604.1988.tb03106.x
Strazzulla A, Chakvetadze C, Picque M, et al. Evolution of haemostatic parameters and risk of bleeding during treatment with cefazolin. Eur J Clin Microbiol Infect Dis 2019;38:177-83. DOI: https://doi.org/10.1007/s10096-018-3412-6
How to Cite
Prolonged prothrombin time in a rare case of vitamin K deficiency: a case report and a narrative review. (2023). Italian Journal of Medicine, 17(3). https://doi.org/10.4081/itjm.2023.1665
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