April 1988, Vol 123, No. 4 >

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ARTICLE | April 1988

Hypoprothrombinemia and Bleeding Diathesis Associated With Cefotetan Therapy in Surgical Patients

JACK HOLT, MD

Arch Surg. 1988;123(4):523. doi:10.1001/archsurg.1988.01400280137028.

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To the Editor.—Cefotetan disodium, like moxalactam, cefoperazone, and cefamandole, contains an N-methylthiotetrazole (MTT) side chain that has been associated with hypoprothrombinemia and bleeding diathesis. Previously, cefotetan has been implicated in hypoprothrombinemia, without clinical bleeding, in patients with phytonadione (vitamin K₁) deficiency.¹ Two case reports of hypoprothrombinemia in surgical patients, with hemorrhage occurring in one patient, treated with cefotetan, are described.

Report of Cases.—Case 1.—An 86-year-old woman with a medical history significant for hypertension and kidney stones presented with pain in the right lower quadrant. Laboratory analysis revealed a hematocrit of 0.36 (36%), a white blood cell count of 21 × 10⁹/L (21 × 10³/mm³) (neutrophils, 0.90 [90%], band cells, 0.03 [3%]), and prothrombin and partial thromboplastin times of 13.8 s and 26 s, respectively. The coagulation values were within normal limits for Hartford (Conn) Hospital. An upright abdominal roentgenogram showed

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HOLT J. Hypoprothrombinemia and Bleeding Diathesis Associated With Cefotetan Therapy in Surgical Patients. Arch Surg. 1988;123(4):523. doi:10.1001/archsurg.1988.01400280137028.

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Hypoprothrombinemia and Bleeding Diathesis Associated With Cefotetan Therapy in Surgical Patients

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