Case report: Artificial elevation of prothrombin time by telavancin infection

Derek F. Amanatullah, Matthew J. Lopez, Robert C. Gosselin, Munish C. Gupta

Research output: Contribution to journalArticle

2 Scopus citations

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.

Original languageEnglish
Pages (from-to)332-335
Number of pages4
JournalClinical orthopaedics and related research
Volume471
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

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