Postoperative abnormal prothrombinemia in patients with cefoperazone: report of two cases

Two cases of postoperative abnormal prothrombinemia presumably caused by the administration of cefoperazone are herein described. One patient, who had bile duct cancer with obstructive jaundice, underwent resection of the extrahepatic bile duct with hepaticojejunostomy (Roux-en-Y anastomosis) and partial resection of the liver following percutaneous transhepatic cholangial drainage. He developed abnormal prothrombinemia and bleeding 10 days after surgery. The other patient, who had undergone a total gastrectomy 17 years earlier, suffered from pulmonary tuberculosis. She was initiated anti-tuberculous regimen and simultaneously was worked-up for her severe anemia, and was found to have ascending colon cancer. She underwent a right hemicolectomy, cholecystectomy, and repair of ventral incisional hernia, and subsequently developed abnormal prothrombinemia and bleeding 12 days after surgery. Both patients received a chemical bowel preparation prior to surgery. Prothrombin time was normal preoperatively in both patients. Both patients were treated with fresh frozen plasma and intravenous menatetrenon, which improved the clotting disorder within 24h. Antibiotics containing the N-methyl-thio-tetrazol side chain should thus be used with particular prudence in patients with abnormal prothrombinemia and a tendency to develop bleeding disorders.