Summary
21 Patients with normal and impaired renal function were given cefoperazone in a recommended dose of 4 g/day, irrespective of renal function. Platelet function and plasmatic coagulation were analyzed before and on day 7 of therapy. In patients with normal renal function on their usual diets, there was neither impairment of platelet function nor plasmatic coagulation. High serum antibiotic trough levels, prolongation of bleeding time and decreased vitamin K-dependent coagulation factors, as verified by the prolongation of prothrombin time and the appearance of descarboxyprothrombin, could be observed in those patients with impaired renal function whose insufficiency was far advanced and accompanied by a complex clinical picture. In this situation vitamin K deficiency may be due to poor oral intake, along with interference of hepatic vitamin K metabolism, showing an effect similar to that seen after coumarin therapy. Dosage reduction of the antibiotic in advanced renal failure and repeated control of prothrombin time is advised.
Zusammenfassung
21 Patienten erhielten eine tägliche Standarddosis von 4 g Cefoperazon ohne Rücksicht auf die Nierenfunktion. Thrombozytenfunktion und plasmatische Gerinnung wurden vor und am Tag 7 der Therapie mit Cefoperazon untersucht. Bei Patienten mit normaler Nierenfunktion blieb die Hämostase unverändert. Dagegen trat bei Patienten mit präterminaler Urämie und zusätzlicher komplexer klinischer Situation eine Hämostasestörung auf, welche durch hohe Antibiotikatalspiegel verursacht war. Die gestörte Hämostase war gekennzeichnet durch eine verlängerte Blutungszeit und durch eine Erniedrigung des Quickwertes, hervorgerufen durch einen erworbenen Vitamin-K-Mangel. Ursache des Vitamin-K-Mangels war eine verminderte Zufuhr mit der Nahrung und eine kumarinähnliche Hemmung der hepatischen reduktiven Regeneration von Vitamin K. Um Hämostasestörungen zu vermeiden, werden bei Patienten mit präterminaler Urämie eine Dosisreduktion von Cefoperazon und häufige Kontrollen des Quickwertes empfohlen.
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Andrassy, K., Koderisch, J., Fritz, S. et al. Alteration of hemostasis associated with cefoperazone treatment. Infection 14, 27–31 (1986). https://doi.org/10.1007/BF01644806
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DOI: https://doi.org/10.1007/BF01644806