Case Report: Artificial Elevation of Prothrombin Time by Telavancin

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2012 Nov 7

PMID 23129464

Citations 2

Authors

Derek F Amanatullah

Matthew J Lopez

Robert C Gosselin

Munish C Gupta

Affiliations

Soon will be listed here.

Abstract

Background: Methicillin-resistant Staphylococcus aureus infections are a well-documented risk of surgery and are becoming increasingly difficult to treat owing to continued acquired resistance. A new antibiotic for treatment of Staphylococcus aureus is telavancin.

Case Description: A patient at our institution was prescribed telavancin for multiple spinal abscesses before spinal surgery. Routine preoperative testing revealed an international normalized ratio (INR) of 2.05 with no clear cause. Careful review of the patient's medication history and prescriber information revealed that telavancin may interfere with prothrombin time (PT/INR) testing. In vitro testing by our laboratory confirmed an association between telavancin dose and an increase in PT/INR. An alternative reagent for PT/INR testing unaffected by telavancin dose revealed a PT/INR of 0.97.

Literature Review: Telavancin interacts with artificial phospholipid surfaces used to monitor coagulation while having no actual effect on coagulation.

Purposes And Clinical Relevance: All physicians, especially orthopaedic surgeons, should be aware of the effects of telavancin and ensure proper measures are taken to acquire the true INR by switching the reagent used to test PT/INR or ensuring the PT/INR is drawn before telavancin dosing.

Citing Articles

Telavancin: a novel semisynthetic lipoglycopeptide agent to counter the challenge of resistant Gram-positive pathogens.

Das B, Sarkar C, Das D, Gupta A, Kalra A, Sahni S Ther Adv Infect Dis. 2017; 4(2):49-73.

PMID: 28634536 PMC: 5467880. DOI: 10.1177/2049936117690501.

Impact of telavancin on prothrombin time and activated partial thromboplastin time as determined using point-of-care coagulometers.

Ero M, Harvey N, Harbert J, Janc J, Chin K, Barriere S J Thromb Thrombolysis. 2013; 38(2):235-40.

PMID: 24132401 DOI: 10.1007/s11239-013-1004-y.

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