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The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

1
College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea
2
Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Korea
3
Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
4
Department of Thoracic & Cardiovascular Surgery, SNU-SMG Boramae Hospital, Seoul 07061, Korea
5
Department of Thoracic & Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul 07061, Korea
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2019, 16(20), 3937; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203937
Received: 18 September 2019 / Revised: 14 October 2019 / Accepted: 15 October 2019 / Published: 16 October 2019
(This article belongs to the Section Health Care Sciences & Services)
Cephalosporins that contain the N-methylthiotetrazole side chain (NMTT-cephalosporin) have been reported to be associated with coagulation-related adverse events; however, a comprehensive evaluation regarding the association is lacking. A systematic review and meta-analysis were conducted to assess the safety profile of NMTT-cephalosporins with respect to hypoprothrombinemia and bleeding. The MEDLINE, Embase, Cochrane, and RISS databases were systematically searched for clinical studies up to October 2018. The association between NMTT-cephalosporins and hypoprothrombinemia was estimated using an odds ratio (OR) with a 95% confidence interval (CI). A total of 15 studies on cefamandole, cefoperazone, cefotetan, cefmetazole, and moxalactam were identified and included in the meta-analysis. Hypoprothrombinemia (OR 1.676, 95% CI 1.275–2.203) and prothrombin time (PT) prolongation (OR 2.050, 95% CI 1.398–3.005) were significantly associated with NMTT-cephalosporins, whereas bleeding was not (OR 1.359, 95% CI 0.920–2.009). Subgroup analyses revealed that cefoperazone (OR 2.506, 95% CI 1.293–4.860), cefamandole (OR 3.247, 95% CI 1.083–9.733), and moxalactam (OR 3.367, 95% CI 1.725–6.572) were significantly associated with hypoprothrombinemia. An Antimicrobial Stewardship Program led by a multidisciplinary team could play a critical role in monitoring cephalosporin-related hypoprothrombinemia or PT prolongation in patients with underlying clinical conditions at risk for bleeding. The multidisciplinary team could also assist in communicating the potential safety concerns regarding NMTT-cephalosporin use with healthcare professionals to decrease the risk of adverse events. View Full-Text
Keywords: cephalosporins; hypoprothrombinemia; prothrombin time; bleeding cephalosporins; hypoprothrombinemia; prothrombin time; bleeding
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MDPI and ACS Style

Park, G.H.; Kim, S.; Kim, M.S.; Yu, Y.M.; Kim, G.H.; Lee, J.S.; Lee, E. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2019, 16, 3937. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203937

AMA Style

Park GH, Kim S, Kim MS, Yu YM, Kim GH, Lee JS, Lee E. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2019; 16(20):3937. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203937

Chicago/Turabian Style

Park, Gi H., Seungyeon Kim, Min S. Kim, Yun M. Yu, Gun H. Kim, Jeong S. Lee, and Euni Lee. 2019. "The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 16, no. 20: 3937. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203937

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