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Severe delayed coagulopathy caused by cefoperazone/sulbactam: A case report

Siqin Sun1, Yixuan Wang2, Jie Min1

  • 1Department of Pharmacy, West China Hospital, Sichuan University, China.

The Journal of International Medical Research
|October 1, 2025
PubMed

Insights

Cefoperazone/sulbactam may cause severe coagulopathy by inhibiting the vitamin K cycle. Prompt vitamin K1 treatment significantly improved coagulation in a patient with bacterial pneumonia, highlighting the need for vigilant monitoring in at-risk individuals.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Hematology

Background:

  • Severe coagulopathy is a potential adverse reaction linked to antibiotic use.
  • Cefoperazone/sulbactam is an antibiotic combination used for bacterial infections.
  • Vitamin K is essential for the synthesis of clotting factors.

Purpose of the Study:

  • To report a case of severe coagulopathy suspected to be caused by cefoperazone/sulbactam.
  • To investigate the potential mechanism involving vitamin K cycle inhibition.
  • To emphasize the importance of monitoring coagulation parameters during cefoperazone/sulbactam therapy.

Main Methods:

  • A case report of a patient with bacterial pneumonia treated with cefoperazone/sulbactam.
  • Administration of intravenous cefoperazone/sulbactam (1.5g every 8h) for 23 days.
  • Monitoring of coagulation parameters (prothrombin time, activated partial thromboplastin time, international normalized ratio) and assessment using the Naranjo scale.

Main Results:

  • The patient developed prolonged clotting time on day 26 of treatment.
  • Coagulation parameters significantly improved after vitamin K1 administration (PT -88.4%, aPTT -61.1%, INR -88.5%).
  • Naranjo assessment score of 5 suggested a probable relationship between coagulopathy and cefoperazone/sulbactam.

Conclusions:

  • Cefoperazone/sulbactam may induce coagulopathy through vitamin K cycle inhibition, leading to deficiency.
  • Vitamin K1 therapy can effectively reverse this antibiotic-induced coagulopathy.
  • Extended monitoring for coagulopathy is crucial in patients receiving cefoperazone/sulbactam, especially those at high risk for bleeding.
Keywords:
Cefoperazoneadverse reactioncase reportcoagulopathysulbactam

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