Clinical Laboratory of Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Street, Ningbo, Zhejiang Province, China.
BMC Geriatr. 2022 Jul 30;22(1):628. doi: 10.1186/s12877-022-03327-6.
The development of coagulation disorders can be dangerous and fatal in the older people, especially those with multiple medical conditions. Vitamin K-dependent coagulation disorders are easily overlooked when anticoagulant drugs are not used and the patient shows no signs of bleeding.
We report a case of a 71-year-old male suffering from pulmonary infection with severe coagulation disorder without bleeding symptoms. He also had a history of Parkinson's disease, Alzheimer's disease and cardiac insufficiency. Coagulation tests were normal at the time of admission, prothrombin time (PT) is 13.9 (normal, 9.5-13.1) seconds and the activated partial thromboplastin time (APTT) is 30.2 (normal, 25.1-36.5) seconds. But it turned severely abnormal after 20 days (PT: 136.1 s, APTT: 54.8 s). However, no anticoagulants such as warfarin was used and no bleeding symptoms were observed. Subsequent mixing studies with normal plasma showed a decrease in prothrombin times. Vitamin K deficiency was thought to be the cause of coagulation disorders considering long-term antibiotic therapy, especially cephalosporins, inadequate diet and abnormal liver function. After supplementation with 20 mg of vitamin K, coagulation dysfunction was rescued the next day and serious consequences were effectively prevented.
Overall, timely vitamin K supplementation with antimicrobials that affect vitamin K metabolism requires clinician attention, especially in older patients who are multimorbid, frail or nutritionally compromised, and are admitted to hospital because of an infection that needs antimicrobial therapy are at risk of clotting disorders due to abnormal vitamin K metabolism secondary to altered gut flora, which can exacerbate existing nutritional deficiencies.
在老年人中，凝血功能障碍的发展可能是危险和致命的，尤其是那些患有多种疾病的老年人。当不使用抗凝药物且患者没有出血迹象时，维生素 K 依赖性凝血功能障碍很容易被忽视。
我们报告了一例 71 岁男性患有肺部感染，伴有严重凝血功能障碍但无出血症状。他还患有帕金森病、阿尔茨海默病和心功能不全。入院时凝血检查正常，凝血酶原时间（PT）为 13.9（正常范围为 9.5-13.1）秒，活化部分凝血活酶时间（APTT）为 30.2（正常范围为 25.1-36.5）秒。但 20 天后，凝血功能严重异常（PT：136.1 秒，APTT：54.8 秒）。然而，没有使用华法林等抗凝药物，也没有观察到出血症状。随后与正常血浆混合研究显示凝血酶原时间降低。考虑到长期抗生素治疗，特别是头孢菌素类抗生素，饮食不当和肝功能异常，认为维生素 K 缺乏是导致凝血功能障碍的原因。补充 20 毫克维生素 K 后，第二天凝血功能障碍得到纠正，有效预防了严重后果。
总之，需要临床医生注意及时补充维生素 K，并避免使用影响维生素 K 代谢的抗生素，特别是在患有多种疾病、虚弱或营养受损的老年患者中，由于改变的肠道菌群导致维生素 K 代谢异常而发生凝血功能障碍，以及因感染而需要抗菌治疗的患者，这可能会加重现有的营养缺乏。
