Evidence for Impaired Hepatic Vitamin K₁ Metabolism in Patients Treated with N-Methyl-Thiotetrazole Cephalosporins

Summary

In 8 patients on no oral intake and with parenteral alimentation, administration of cephalosporins with N-methyl-thiotetrazole side chain (moxalactam, cefamandole), was associated with prolongation of prothrombin time, appearance in the circulation of descarboxy-prothrombin (counter immunoelectrophoresis and echis carinatus assay) and diminution of protein C. Acute administration of 10 mg vitamin Ki was followed by the transient appearance of vitamin K₁ 2,3-epoxide, indicating an impaired hepatocellular regeneration of vitamin K₁ from the epoxide. Impaired hepatic vitamin K₁ metabolism, tentatively ascribed to the N-methyl-thiotetrazole group, is one (but possibly not the only) cause of bleeding complications and depression of vitamin K₁dependent procoagulants in patients treated with the new class of cephalosporins.

Keywords

Cephalosporins - Hemostasis - Vitamin K - Descarboxyprothrombin - Protein C

• References

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