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Published on: May 2, 2017
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Cefoperazone-induced Coagulopathy in Critically Ill Patients Admitted to Intensive Care Unit
Kiran Kumar Gudivada1, Bhuvana Krishna1, Sriram Sampath1
1Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
Summary
Cefoperazone-induced coagulopathy (CIC) affects 26% of ICU patients. Therapeutic vitamin K effectively reduces elevated INR, while prophylactic vitamin K shows no benefit. Monitoring INR is recommended for at-risk patients.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Hematology
Background:
- The N-methylthiotetrazole (NMTT) side chain of cefoperazone inhibits vitamin K epoxide reductase, similar to warfarin.
- Vitamin K is hypothesized to counteract the hematological effects of cefoperazone.
- Limited literature exists on cefoperazone-induced coagulopathy (CIC) in critically ill patients.
Purpose of the Study:
- To determine the incidence of CIC in intensive care unit (ICU) patients.
- To evaluate the clinical impact of CIC on bleeding and transfusion needs.
- To identify risk factors for CIC and the efficacy of vitamin K (prophylactic and therapeutic).
Main Methods:
- A prospective observational study was conducted in an ICU from December 2017 to December 2018.
- Included were adult patients receiving cefoperazone, excluding those on warfarin or with pre-existing coagulopathy.
- Data on laboratory results and clinical outcomes were collected for 6 days; panel data regression identified predictors of coagulopathy.
Main Results:
- Of 65 patients, 17 (26%) developed probable CIC.
- Hypoalbuminemia and co-administration of vancomycin were identified as risk factors for CIC.
- Therapeutic vitamin K significantly reduced elevated INR (ARR: 57.5%, NNT: 1.7), whereas prophylactic vitamin K did not prevent INR elevation.
Conclusions:
- CIC is a significant concern in ICU settings.
- Recommend INR monitoring for patients on nephrotoxic agents or with hypoalbuminemia.
- Advise vitamin K administration for patients with elevated INR to manage coagulopathy.
Keywords:
CefoperazoneCoagulopathyCritically ill adultsInternational normalized ratio elevationVitaminMore Related Videos
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