Severe cefazolin-associated coagulopathy corrected with vitamin K supplementation : a case report
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Cefazolin, a commonly used antibiotic in clinical practice, has been associated with coagulation disorders, including hypoprothrombinemia and elevated international normalized ratio (INR) in the absence of vitamin K antagonist administration. However, these cases often involve patients with renal dysfunction or malnutrition. We present a unique case of a 66-year-old male with severe cefazolin- associated coagulopathy despite normal kidney function. The patient had a complex medical history, including heart failure with preserved ejection fraction and rheumatoid arthritis on immunosuppression therapy. He was initially admitted to the hospital with COVID-19, acute pulmonary embolism, and non-ST-segment elevation myocardial infarction. Subsequently, he developed methicillin-sensitive Staphylococcus aureus bacteremia and epidural abscesses, for which high-dose cefazolin was initiated. The patient presented with gross hematuria and hematochezia, along with an elevated INR and prolonged prothrombin time. Despite holding rivaroxaban, his coagulation profile remained abnormal. After vitamin K administration and discontinuation of cefazolin, the INR quickly corrected. This case highlights the need for monitoring cefazolin therapy in patients with hemorrhagic complications to assess for coagulopathy.
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