Impaired platelet function associated with parenteral nafcillin

• Published in: Annals of clinical and laboratory science Vol. 20; no. 1; pp. 79 - 84
• Main Authors: JETER, E. K, SCOTT, A, KIZER, J, LAZARCHICK, J
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Institute for Clinical Science 1990
• Subjects: Adult; Biological and medical sciences; Bleeding Time; Cerebral Hemorrhage - drug therapy; Female; Hematologic and hematopoietic diseases; Hematoma, Epidural, Cranial - chemically induced; Humans; In Vitro Techniques; Male; Medical sciences; Nafcillin - adverse effects; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors; Platelet Count; Postoperative Care; Human; Hemopathy; Disease; Coagulopathy; Etiopathogenesis; Platelet function
• ISSN: 0091-7370; 1550-8080

A 44-year-old Caucasian female was admitted with a subarachnoid hemorrhage owing to a multilobular tubular anterior communicating artery aneurysm. Eleven days after the original craniotomy, an epidural hematoma was evacuated. The patient was placed on empiric nafcillin antimicrobial coverage (two g every six hours). Within 24 hours, the onset of epistaxis and oozing of blood from the endotracheal tube and craniotomy site was noted. Recurrent subdural and epidural hematomas necessitated a third emergent craniotomy. The development of an acquired qualitative platelet defect was suggested by the findings of a prolonged template bleeding time and markedly abnormal platelet aggregation/ATP release studies despite a normal platelet count. Nafcillin therapy was immediately discontinued. Clinical bleeding resolved. Subsequent bleeding times and platelet aggregation studies confirmed the nafcillin-induced platelet dysfunction.