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Clinical Orthopaedics and Related Research®

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01-01-2013 | Case Report

Case Report: Artificial Elevation of Prothrombin Time by Telavancin

Authors: Derek F. Amanatullah, MD, PhD, Matthew J. Lopez, BS, Robert C. Gosselin, CLS, Munish C. Gupta, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2013

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.

Astellas Pharma US Inc. Telavancin Package Insert. Deerfield, IL: Astellas Pharma US, Inc; 2009.

Barriere SL, Goldberg MR, Janc JW, Higgins DL, Macy PA, Adcock DM. Effects of telavancin on coagulation test results. Int J Clin Pract. 2011;65:784–789.PubMedCrossRef

Corey GR, Stryjewski ME, Weyenberg W, Yasothan U, Kirkpatrick P. Telavancin. Nat Rev Drug Discov. 2009;8:929–930.PubMedCrossRef

Damodaran SE, Madham S. Telavancin: a novel lipoglycopeptide antibiotic. J Pharmacol Pharmacother. 2011;2:135–137.PubMedCrossRef

Gosselin R, Dager W, Roberts A, Freeman L, Gandy L, Gregg J, Dwyre D. Effect of telavancin (Vibativ) on routine coagulation test results. Am J Clin Pathol. 2011;136:848–854.PubMedCrossRef

Higgins DL, Chang R, Debabov DV, Leung J, Wu T, Krause KM, Sandvik E, Hubbard JM, Kaniga K, Schmidt DE Jr, Gao Q, Cass RT, Karr DE, Benton BM, Humphrey PP. Telavancin, a multifunctional lipoglycopeptide, disrupts both cell wall synthesis and cell membrane integrity in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2005;49:1127–1134.PubMedCrossRef

Hughes B. 2009 FDA drug approvals. Nat Rev Drug Discov. 2010;9:89–92.PubMedCrossRef

Kim DH, Spencer M, Davidson SM, Li L, Shaw JD, Gulczynski D, Hunter DJ, Martha JF, Miley GB, Parazin SJ, Dejoie P, Richmond JC. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am. 2010;92:1820–1826.PubMedCrossRef

Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, Rybak MJ, Talan DA, Chambers HF. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52:e18–e55.PubMedCrossRef

10.

Lunde CS, Hartouni SR, Janc JW, Mammen M, Humphrey PP, Benton BM. Telavancin disrupts the functional integrity of the bacterial membrane through targeted interaction with the cell wall precursor lipid II. Antimicrob Agents Chemother. 2009;53:3375–3383.PubMedCrossRef

11.

Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G. Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br. 2006;88:812–817.PubMedCrossRef

12.

Shaw JP, Cheong J, Goldberg MR, Kitt MM. Mass balance and pharmacokinetics of [14C]telavancin following intravenous administration to healthy male volunteers. Antimicrob Agents Chemother. 2010;54:3365–3371.PubMedCrossRef

13.

Shaw JP, Seroogy J, Kaniga K, Higgins DL, Kitt M, Barriere S. Pharmacokinetics, serum inhibitory and bactericidal activity, and safety of telavancin in healthy subjects. Antimicrob Agents Chemother. 2005;49:195–201.PubMedCrossRef

14.

Wong SL, Barriere SL, Kitt MM, Goldberg MR. Multiple-dose pharmacokinetics of intravenous telavancin in healthy male and female subjects. J Antimicrob Chemother. 2008;62:780–783.PubMedCrossRef

Title: Case Report: Artificial Elevation of Prothrombin Time by Telavancin
Authors: Derek F. Amanatullah, MD, PhD
Matthew J. Lopez, BS
Robert C. Gosselin, CLS
Munish C. Gupta, MD
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2612-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Case Report: Artificial Elevation of Prothrombin Time by Telavancin

Abstract

Background

Case Description

Literature Review

Purposes and Clinical Relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case Description

Literature Review

Purposes and Clinical Relevance

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