FRED R. SATTLER, M.D.; MICHAEL R. WEITEKAMP, M.D.; JAMES O. BALLARD, M.D.
Several new beta-lactam antibiotics impair normal hemostasis. Hypoprothrombinemia has occurred frequently with cephalosporins that possess a methylthiotetrazole substitution (cefamandole, moxalactam, and cefoperazone). The incidence ranges from 4% to 68%, and the risk is greatest in debilitated patients with cancer, intra-abdominal infection, or renal failure. Impaired platelet function caused by perturbation of agonist receptors on the platelet surface has occurred primarily with beta-lactam antibiotics having an alphacarboxyl substitution (moxalactam, carbenicillin, and ticarcillin). These antibiotics often cause the template bleeding time to be markedly prolonged (> 20 minutes). Acylureidopenicillins, which lack the alpha-carboxyl marker, impair platelet function less frequently and only modestly prolong the bleeding time. If serious hemorrhage occurs, hypoprothrombinemia associated with methylthiotetrazole-substituted cephalosporins should be treated with fresh frozen plasma. Likewise, dangerous bleeding due to impaired platelet aggregation requires treatment with platelet concentrates.
SATTLER FR, WEITEKAMP MR, BALLARD JO. Potential for Bleeding with the New Beta-Lactam Antibiotics. Ann Intern Med. 1986;105:924–931. doi: https://doi.org/10.7326/0003-4819-105-6-924
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Published: Ann Intern Med. 1986;105(6):924-931.
Coagulopathies, Hematology/Oncology, Nephrology.
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