Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature
Vitamin K is a lipid-soluble vitamin that is normally maintained within appropriate levels by means of dietary intake and bacterial production in the intestinal microflora. It holds a central role in coagulation homeostasis, and thus its depletion leads to hypocoagulation and haemorrhagic diathesis....
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/13/9/1349 |
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| author | Andreas M. Matthaiou Ioannis Tomos Sofia Chaniotaki Dimitrios Liakopoulos Katerina Sakellaropoulou Sofia Koukidou Loredana-Mariana Gheorghe Stefanos Eskioglou Angeliki Paspalli Georgios Hillas Katerina Dimakou |
| author_facet | Andreas M. Matthaiou Ioannis Tomos Sofia Chaniotaki Dimitrios Liakopoulos Katerina Sakellaropoulou Sofia Koukidou Loredana-Mariana Gheorghe Stefanos Eskioglou Angeliki Paspalli Georgios Hillas Katerina Dimakou |
| author_sort | Andreas M. Matthaiou |
| collection | DOAJ |
| description | Vitamin K is a lipid-soluble vitamin that is normally maintained within appropriate levels by means of dietary intake and bacterial production in the intestinal microflora. It holds a central role in coagulation homeostasis, and thus its depletion leads to hypocoagulation and haemorrhagic diathesis. The association of antibiotic therapy and vitamin E supplementation with vitamin K deficiency was previously described in animal experiments, clinical studies, and case reports. Broad-spectrum antibiotic therapy potentially leads to intestinal microflora dysbiosis and restriction of vitamin K-producing bacterial populations, resulting in decreased vitamin K levels, whereas antibiotics of the cephalosporin class with 1-<i>N</i>-methyl-5-thiotetrazole (NMTT) or 2-methyl-1,3,4-thiadiazole (MTD) side groups inhibit vitamin K function. Vitamin E supplementation interferes with both the bioavailability and function of vitamin K, yet its mechanisms are not fully understood. We present the case of a 45-year-old male patient, with a history of epilepsy and schizophrenia, catatonically incapacitated and immobilised, who was hospitalised in our centre for the investigation and management of aspiration pneumonia. He demonstrated a progressively worsening prolongation of international normalised ratio (INR), which was attributed to both broad-spectrum antibiotic therapy and vitamin E supplementation and was reversed upon administration of vitamin K. We highlight the need for close monitoring of coagulation parameters in patients receiving broad-spectrum antibiotic therapy, especially those with underlying malnutritive or malabsorptive conditions, and we further recommend the avoidance of NMTT- or MTD-containing antibiotics or vitamin E supplementation, unless absolutely necessary, in those patients. |
| first_indexed | 2024-03-10T22:34:07Z |
| format | Article |
| id | doaj.art-6ea8eeb223ab4c19a64af25b03b45360 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-10T22:34:07Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-6ea8eeb223ab4c19a64af25b03b453602023-11-19T11:30:59ZengMDPI AGJournal of Personalized Medicine2075-44262023-08-01139134910.3390/jpm13091349Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the LiteratureAndreas M. Matthaiou0Ioannis Tomos1Sofia Chaniotaki2Dimitrios Liakopoulos3Katerina Sakellaropoulou4Sofia Koukidou5Loredana-Mariana Gheorghe6Stefanos Eskioglou7Angeliki Paspalli8Georgios Hillas9Katerina Dimakou105th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, GreeceDepartment of Laboratory Haematology, Georgios Gennimatas General Hospital of Athens, 11527 Athens, GreeceDepartment of Laboratory Haematology, Georgios Gennimatas General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, GreeceDepartment of Laboratory Haematology, Georgios Gennimatas General Hospital of Athens, 11527 Athens, GreeceDepartment of Laboratory Haematology, Georgios Gennimatas General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, Greece5th Department of Respiratory Medicine, Sotiria Thoracic Diseases General Hospital of Athens, 11527 Athens, GreeceVitamin K is a lipid-soluble vitamin that is normally maintained within appropriate levels by means of dietary intake and bacterial production in the intestinal microflora. It holds a central role in coagulation homeostasis, and thus its depletion leads to hypocoagulation and haemorrhagic diathesis. The association of antibiotic therapy and vitamin E supplementation with vitamin K deficiency was previously described in animal experiments, clinical studies, and case reports. Broad-spectrum antibiotic therapy potentially leads to intestinal microflora dysbiosis and restriction of vitamin K-producing bacterial populations, resulting in decreased vitamin K levels, whereas antibiotics of the cephalosporin class with 1-<i>N</i>-methyl-5-thiotetrazole (NMTT) or 2-methyl-1,3,4-thiadiazole (MTD) side groups inhibit vitamin K function. Vitamin E supplementation interferes with both the bioavailability and function of vitamin K, yet its mechanisms are not fully understood. We present the case of a 45-year-old male patient, with a history of epilepsy and schizophrenia, catatonically incapacitated and immobilised, who was hospitalised in our centre for the investigation and management of aspiration pneumonia. He demonstrated a progressively worsening prolongation of international normalised ratio (INR), which was attributed to both broad-spectrum antibiotic therapy and vitamin E supplementation and was reversed upon administration of vitamin K. We highlight the need for close monitoring of coagulation parameters in patients receiving broad-spectrum antibiotic therapy, especially those with underlying malnutritive or malabsorptive conditions, and we further recommend the avoidance of NMTT- or MTD-containing antibiotics or vitamin E supplementation, unless absolutely necessary, in those patients.https://www.mdpi.com/2075-4426/13/9/1349vitamin Kantibioticsvitamin Einternational normalised ratioprothrombin timecoagulopathy |
| spellingShingle | Andreas M. Matthaiou Ioannis Tomos Sofia Chaniotaki Dimitrios Liakopoulos Katerina Sakellaropoulou Sofia Koukidou Loredana-Mariana Gheorghe Stefanos Eskioglou Angeliki Paspalli Georgios Hillas Katerina Dimakou Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature Journal of Personalized Medicine vitamin K antibiotics vitamin E international normalised ratio prothrombin time coagulopathy |
| title | Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature |
| title_full | Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature |
| title_fullStr | Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature |
| title_full_unstemmed | Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature |
| title_short | Association of Broad-Spectrum Antibiotic Therapy and Vitamin E Supplementation with Vitamin K Deficiency-Induced Coagulopathy: A Case Report and Narrative Review of the Literature |
| title_sort | association of broad spectrum antibiotic therapy and vitamin e supplementation with vitamin k deficiency induced coagulopathy a case report and narrative review of the literature |
| topic | vitamin K antibiotics vitamin E international normalised ratio prothrombin time coagulopathy |
| url | https://www.mdpi.com/2075-4426/13/9/1349 |
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