{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:09:47Z","timestamp":1777417787932,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[1997,2,1]],"date-time":"1997-02-01T00:00:00Z","timestamp":854755200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[1997,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (FT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/106002809703100210","type":"journal-article","created":{"date-parts":[[2017,5,30]],"date-time":"2017-05-30T06:10:48Z","timestamp":1496124648000},"page":"180-184","source":"Crossref","is-referenced-by-count":15,"title":["Hypoprothrombinemia Associated with Cefmetazole"],"prefix":"10.1177","volume":"31","author":[{"given":"Gail A","family":"Breen","sequence":"first","affiliation":[{"name":"The Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy L St","family":"Peter","sequence":"additional","affiliation":[{"name":"The Drug Evaluation Unit, Hennepin County Medical Center, and College of Pharmacy, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,5,30]]},"reference":[{"key":"bibr1-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1990.tb03476.x"},{"key":"bibr2-106002809703100210","first-page":"239","volume":"30","author":"Naranjo C.A.","year":"1981","journal-title":"Clin Pharmacol"},{"key":"bibr3-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1979.03300070019017"},{"key":"bibr4-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/23.suppl_D.47"},{"key":"bibr5-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/23.suppl_D.21"},{"key":"bibr6-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/23.suppl_D.131"},{"key":"bibr7-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1977.tb00719.x"},{"key":"bibr8-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(88)80209-5"},{"key":"bibr9-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(85)90268-2"},{"key":"bibr10-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(83)90174-5"},{"key":"bibr11-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1016\/0049-3848(84)90118-X"},{"key":"bibr12-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1016\/0006-2952(86)90472-7"},{"key":"bibr13-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1661101"},{"key":"bibr14-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1988.tb03106.x"},{"key":"bibr15-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1988.tb04180.x"},{"key":"bibr16-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198708000-00007"},{"key":"bibr17-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1986.00360180117019"},{"key":"bibr18-106002809703100210","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1985.tb123092.x"},{"key":"bibr19-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198711000-00007"},{"key":"bibr20-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198504000-00035"},{"key":"bibr21-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1991.01410280128021"},{"key":"bibr22-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1982.03330090070035"},{"key":"bibr23-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1159\/000187046"},{"key":"bibr24-106002809703100210","doi-asserted-by":"publisher","DOI":"10.1159\/000188381"},{"key":"bibr25-106002809703100210","first-page":"1094","volume":"86","author":"Danan G","year":"1991","journal-title":"Am J Gastroenterol"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/106002809703100210","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/106002809703100210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:05:45Z","timestamp":1777374345000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.sagepub.com\/doi\/10.1177\/106002809703100210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,2]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1997,2]]}},"alternative-id":["10.1177\/106002809703100210"],"URL":"https:\/\/doi.org\/10.1177\/106002809703100210","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,2]]}}}