Piperacillin/tazobactam-induced coagulopathy in a patient through a vitamin K-dependent mechanism

Area of Science:

• Internal Medicine
• Pharmacology
• Hematology

Background:

• Piperacillin/tazobactam (PTZ) is a broad-spectrum antibiotic commonly used for severe infections.
• Haematologic side effects, including coagulopathy, are rare but potentially fatal complications of PTZ therapy.
• The precise mechanism underlying PTZ-induced haemorrhage remains unclear.

Observation:

• A 70-year-old female patient with severe pneumonia and pulmonary thromboembolism received empirical PTZ treatment.
• The patient presented with an elevated international normalised ratio (INR), which worsened upon PTZ reinitiation.
• Coagulopathy was successfully reversed following vitamin K supplementation.

Findings:

• PTZ administration was associated with the development of a coagulopathy.
• The coagulopathy exhibited a vitamin K-dependent mechanism, evidenced by its reversal with vitamin K.
• This case is the first to propose a vitamin K-dependent mechanism for PTZ-induced coagulopathy.

Implications:

• PTZ may induce coagulopathy through interference with vitamin K metabolism.
• Patients with risk factors for vitamin K deficiency require careful monitoring for coagulopathy during PTZ treatment.
• Monitoring for coagulopathy is recommended for patients receiving piperacillin or other broad-spectrum antibiotics, especially those with vitamin K deficiency risk.