Sattler F R, Weitekamp M R, Ballard J O
Ann Intern Med. 1986 Dec;105(6):924-31. doi: 10.7326/0003-4819-105-6-924.
Several new beta-lactam antibiotics impair normal hemostasis. Hypoprothrombinemia has occurred frequently with cephalosporins that possess a methylthiotetrazole substitution (cefamandole, moxalactam, and cefoperazone). The incidence ranges from 4% to 68%, and the risk is greatest in debilitated patients with cancer, intra-abdominal infection, or renal failure. Impaired platelet function caused by perturbation of agonist receptors on the platelet surface has occurred primarily with beta-lactam antibiotics having an alpha-carboxyl substitution (moxalactam, carbenicillin, and ticarcillin). These antibiotics often cause the template bleeding time to be markedly prolonged (greater than 20 minutes). Acylureidopenicillins, which lack the alpha-carboxyl marker, impair platelet function less frequently and only modestly prolong the bleeding time. If serious hemorrhage occurs, hypoprothrombinemia associated with methylthiotetrazole-substituted cephalosporins should be treated with fresh frozen plasma. Likewise, dangerous bleeding due to impaired platelet aggregation requires treatment with platelet concentrates.
几种新型β-内酰胺类抗生素会损害正常的止血功能。具有甲基硫代四氮唑取代基的头孢菌素（头孢孟多、拉氧头孢和头孢哌酮）常导致低凝血酶原血症。发生率在4%至68%之间，在患有癌症、腹腔内感染或肾衰竭的虚弱患者中风险最大。血小板表面激动剂受体受干扰导致的血小板功能受损主要发生在具有α-羧基取代基的β-内酰胺类抗生素（拉氧头孢、羧苄西林和替卡西林）身上。这些抗生素常使模板出血时间显著延长（超过20分钟）。缺乏α-羧基标记的酰脲类青霉素较少损害血小板功能，仅适度延长出血时间。如果发生严重出血，与甲基硫代四氮唑取代的头孢菌素相关的低凝血酶原血症应使用新鲜冰冻血浆治疗。同样，由于血小板聚集受损导致的危险出血需要用血小板浓缩物治疗。
