title: [Suspicious case of epidural hematoma due to coagulopathy caused by vitamin K deficiency associated with antibiotics].
abstract: We experienced a case of epidural hematoma caused by coagulopathy 3 days after surgery. A 72-year-old man, who had undergone a total gastrectomy, suffered from nausea and vomiting by ileus. He underwent repair of ileus under general anesthesia with thoracic epidural anesthesia. Three days after surgery, abnormal bleeding followed by disorder of prothrombin activity (PT) and activated partial thromboplastin time (aPTT) and paralysis due to thoracic epidural hematoma developed. It was suspected that these coagulopathies were the results of vitamin K deficiency. Vitamin K deficiency in this patient was considered to have been caused by cephem antibiotics containing N-methyl-thiotetrazole (NMTT) side chain and no oral intake of food for a few days preoperatively. The patient was treated with fresh frozen plasma and intravenous menatetrenon, which improved abnormal bleeding and disorder of PT and aPTT within 24hr. After a discussion with orthopedic consultants, we selected a conservative therapy rather than surgical removal of the hematoma. Thoracic epidural hematoma disappeared two months after surgery, but motor paralysis requiring rehabilitation remained. In conclusion, when patients have not eaten anything for a few days and antibiotics with an NMTT sidechain has been administered, care must be taken to prevent vitamin K deficiency and coagulopathy.
authors.affiliation: Department of Anesthesiology, Sapporo Medical University Sapporo 060-8543.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hirata
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kanaya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimizu
authors.forename: Masanori
authors.initials: M
authors.lastname: Watanabe
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Namiki
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D015780:Carbapenems / Q000009:adverse effects* / Q000737:chemistry; D005743:Gastrectomy; D046748:Hematoma, Epidural, Spinal / Q000209:etiology* / Q000628:therapy; D006801:Humans; D045823:Ileus / Q000601:surgery; D007262:Infusions, Intravenous; D008297:Male; D010949:Plasma; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D013274:Stomach Neoplasms / Q000601:surgery; D013777:Tetrazoles / Q000009:adverse effects; D024482:Vitamin K 2 / Q000008:administration & dosage / Q000031:analogs & derivatives; D014813:Vitamin K Deficiency / Q000139:chemically induced* / Q000150:complications
chemical_list: D015780:Carbapenems; D013777:Tetrazoles; D024482:Vitamin K 2; C038625:1-N-methyl-5-thiotetrazole; C030814:menatetrenone