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A Case of Alveolar Bleeding from Clotting Abnormality by Cefmetazole

Eri Nakano1, Tsubasa Fukuoka1, Nao Takeuchi1

  • 1Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan.

Case Reports in Medicine
|February 27, 2019
PubMed

Insights

Certain cephalosporin antibiotics, like cefmetazole, can cause bleeding by depleting vitamin K-dependent clotting factors. This risk increases when used with direct oral anticoagulants, necessitating careful patient monitoring.

Area of Science:

  • Pharmacology
  • Internal Medicine
  • Hematology

Background:

  • Cephalosporins are widely used first-line antibiotics.
  • Some cephalosporins possess an N-methylthiotetrazole (NMTT) side chain, linked to adverse effects.
  • Vitamin K epoxide reductase inhibition is a known mechanism for certain drug-induced coagulopathies.

Observation:

  • A case of alveolar bleeding secondary to clotting abnormality is reported.
  • The patient developed this condition after cefmetazole administration.
  • Cefmetazole contains the NMTT side chain, associated with increased bleeding risk.

Findings:

  • Cephalosporins with NMTT side chains elevate bleeding event frequency.
  • The mechanism involves vitamin K-dependent clotting factor depletion via vitamin K epoxide reductase inhibition.
  • This action mirrors that of warfarin, a common anticoagulant.

Implications:

  • Concurrent use of NMTT-containing cephalosporins and direct oral anticoagulants may increase bleeding events.
  • This interaction poses a growing clinical concern due to the rising use of anticoagulants.
  • Healthcare providers must be vigilant for bleeding risks in patients on combined therapies.

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