Reversible hypoprothrombinemia in a patient with primary biliary cirrhosis treated with rifampicin.
A patient with primary biliary cirrhosis (PBC) developed marked hypoprothrombinemia with decreased concentrations of the vitamin K-dependent coagulation factors VII, IX, and X during treatment with rifampicin. The coagulation abnormalities were easily corrected by administration of vitamin K. Different mechanisms may be involved, such as a decreased production of menaquinones by intestinal bacteria, a warfarin-like effect by inhibition of the vitamin K epoxide reductase, or an increased oxidative degradation of vitamin K as a result of hepatic microsomal enzyme stimulation. Whatever the mechanism involved, the appearance of this complication in a patient with PBC probably points to the importance of a pre-existing poor vitamin K status. Patients with PBC, treated with rifampicin, should have a regular monitoring of their vitamin K status. Adequate vitamin substitution should be administered, if necessary.
Van Steenbergen
W
W
Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Vermylen
J
J
D005260:Female; D006801:Humans; D007020:Hypoprothrombinemias / Q000139:chemically induced* / Q000188:drug therapy; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy*; D008875:Middle Aged; D011517:Prothrombin Time; D012293:Rifampin / Q000009:adverse effects* / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use; D014813:Vitamin K Deficiency / Q000139:chemically induced* / Q000188:drug therapy
D014812:Vitamin K; D012293:Rifampin