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Hypoprothrombinemia associated with cefmetazole

G A Breen¹, W L St Peter

¹Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, MN 55404, USA.

The Annals of Pharmacotherapy

|February 1, 1997

Summary

Cefmetazole sodium can cause hypoprothrombinemia, a bleeding risk, especially in malnourished patients. Vitamin K prophylaxis is recommended for at-risk individuals using cephalosporins with an NMTT side chain.

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Area of Science:

Pharmacology
Clinical Medicine
Biochemistry

Background:

Antibiotic-associated hypoprothrombinemia is a potential adverse effect of certain cephalosporins.
Cefmetazole sodium, a cephalosporin, has been implicated in causing hypoprothrombinemia.
The N-methylthiotetrazole (NMTT) side chain is a suspected contributor to this adverse effect.

Observation:

A case report details a malnourished patient with end-stage renal disease who developed elevated prothrombin time (PT) and international normalized ratio (INR) after receiving cefmetazole.
The patient, though asymptomatic for bleeding, showed markedly elevated PT/INR values three days post-administration.
Discontinuation of cefmetazole and administration of Vitamin K and fresh frozen plasma led to normalization of PT/INR within 24 hours.

Findings:

The exact incidence of cefmetazole-associated hypoprothrombinemia is inconsistent in literature.
A plausible mechanism involves the NMTT chain inhibiting vitamin K epoxide reductase in the liver.
Risk factors include malnutrition, low albumin, poor intake, elderly status, and renal or liver dysfunction.

Implications:

Clinicians must identify and monitor patients at risk for antibiotic-associated hypoprothrombinemia.
Prophylactic Vitamin K administration should be considered for high-risk patients, particularly those on cephalosporins with an NMTT side chain.
Understanding the risk factors and mechanisms is crucial for preventing and managing this adverse drug event.

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