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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
Summary
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.
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