Cefazolin and Coagulation Disorder: A case report and review of literature

A 63-year old Yemeni male, known case of endstage renal disease (ESRD), hypertension and diabetes mellitus, underwent craniotomy and endoscopic removal of an intraventricular mass. Peri-operatively he was started on cefazolin, a normal diet and regular hemodialysis without heparin. The international normalising ratio (INR) increased rapidly, reaching 4.2 on day five but responded equally rapidly to parenteral Vitamin K and withdrawal of cefazolin. Cefazolin is an antibiotic commonly used in clinical practice because of its long half-life, narrow spectrum and its ability for dose adjustment in renal failure patients. We review the literature, discuss the risk factors of its use and suggest possible mechanisms causing the prolonged coagulation.