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Case Report: Artificial Elevation of Prothrombin Time by Telavancin

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Clinical Orthopaedics and Related Research®

Abstract

Background

Methicillin-resistant Staphylococcus aureus infections are a well-documented risk of surgery and are becoming increasingly difficult to treat owing to continued acquired resistance. A new antibiotic for treatment of Staphylococcus aureus is telavancin.

Case Description

A patient at our institution was prescribed telavancin for multiple spinal abscesses before spinal surgery. Routine preoperative testing revealed an international normalized ratio (INR) of 2.05 with no clear cause. Careful review of the patient’s medication history and prescriber information revealed that telavancin may interfere with prothrombin time (PT/INR) testing. In vitro testing by our laboratory confirmed an association between telavancin dose and an increase in PT/INR. An alternative reagent for PT/INR testing unaffected by telavancin dose revealed a PT/INR of 0.97.

Literature Review

Telavancin interacts with artificial phospholipid surfaces used to monitor coagulation while having no actual effect on coagulation.

Purposes and Clinical Relevance

All physicians, especially orthopaedic surgeons, should be aware of the effects of telavancin and ensure proper measures are taken to acquire the true INR by switching the reagent used to test PT/INR or ensuring the PT/INR is drawn before telavancin dosing.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, Davis Health System, 4860 Y Street, Suite 3800, Sacramento, CA, 95835, USA

    Derek F. Amanatullah MD, PhD, Matthew J. Lopez BS & Munish C. Gupta MD

  2. Department of Pathology and Laboratory Medicine, University of California, Davis Health System, Sacramento, CA, USA

    Robert C. Gosselin CLS

Authors
  1. Derek F. Amanatullah MD, PhD
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  2. Matthew J. Lopez BS
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  3. Robert C. Gosselin CLS
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  4. Munish C. Gupta MD
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Corresponding author

Correspondence to Munish C. Gupta MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

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Amanatullah, D.F., Lopez, M.J., Gosselin, R.C. et al. Case Report: Artificial Elevation of Prothrombin Time by Telavancin. Clin Orthop Relat Res 471, 332–335 (2013). https://doi.org/10.1007/s11999-012-2612-0

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  • DOI: https://doi.org/10.1007/s11999-012-2612-0

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