Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France.
Medical Biology Laboratory, Centre Hospitalier Sud Ile de France, Melun, France.
Eur J Clin Microbiol Infect Dis. 2019 Jan;38(1):177-183. doi: 10.1007/s10096-018-3412-6. Epub 2018 Nov 10.
In 2017, five cases of severe haemorrhages during treatment with cefazolin occurred in France. The aim of this study was to assess the risk of haemorrhage related to treatment with cefazolin by evaluating haemostatic parameters and bleeding events. A retrospective study was conducted from January 2016 to December 2017. Two populations were analysed: (i) overall population, which included all patients treated with cefazolin during this period and (ii) coagulation study population, which included all patients treated with cefazolin with available coagulation parameters (activated partial thromboplastin time (aPTT) and international normalised ratio (INR) at baseline and at the end of treatment or EoT). Values of either aPTT or INR at baseline and at EoT were compared. Cases of severe haemorrhages were reported and correlated with values of aPTT and INR. Overall, 132 patients received cefazolin and 59/132 (45%) were included in the coagulation study group. A significant increase of median aPTT was observed from baseline to EoT (39.5 and 44.3 sec; p = 0.004, respectively). Overall, severe haemorrhage occurred in 7/132 (5%) patients. Coagulation parameters were available in three of them, and no correlation was observed between bleeding events and aPTT increase. This study showed that bleeding is probably more frequent than ever reported before during cefazolin treatment. The significant increase of aPTT observed during cefazolin treatment was not correlated with risk of haemorrhage. Further studies are needed to explore the possible physio-pathological pathways behind the modification of haemostatic parameters and risk of haemorrhage.
2017 年，法国发生了五例头孢唑林治疗期间严重出血的病例。本研究旨在通过评估止血参数和出血事件来评估头孢唑林治疗相关出血的风险。这是一项回顾性研究，时间为 2016 年 1 月至 2017 年 12 月。分析了两个人群：（i）总体人群，包括在此期间接受头孢唑林治疗的所有患者；（ii）凝血研究人群，包括所有接受头孢唑林治疗且具有可用凝血参数（基线和治疗结束时的活化部分凝血活酶时间（aPTT）和国际标准化比值（INR）的患者）。比较了基线和治疗结束时 aPTT 或 INR 的值。报告了严重出血的病例，并与 aPTT 和 INR 值相关联。共有 132 名患者接受了头孢唑林治疗，其中 59/132（45%）纳入了凝血研究组。从基线到治疗结束时，中位数 aPTT 显著增加（分别为 39.5 和 44.3 秒；p=0.004）。共有 7/132（5%）患者发生严重出血。其中三人的凝血参数可用，但未观察到出血事件与 aPTT 增加之间的相关性。本研究表明，在头孢唑林治疗期间，出血的频率可能比以往报道的更为频繁。在头孢唑林治疗期间观察到的 aPTT 显著增加与出血风险无关。需要进一步的研究来探讨止血参数改变和出血风险背后可能的生理病理途径。
