Elevated International Normalized Ratio associated with long-term azithromycin therapy in a child with cerebral palsy

Stork, Christine M.; Marraffa, Jeanna M.; Ragosta, Kevin G.; Wojcik, Susan; Angelino, Kenneth

doi:10.2146/ajhp100603

“…Kannan et al also reported significantly more blood loss during spinal surgery in children with neuromuscular scoliosis compared to those with idiopathic scoliosis ( n = 25) and found reduced factor VII activity ( 238 ). Children with CP are also often taking medication which can effect coagulation, as reported in several case reports, such as valproate ( 239 , 240 ), carbamazepine ( 241 ), and azithromycin ( 242 ). Therefore, consideration of coagulopathy and thrombophilia in children with CP is important, particularly prior to surgery, including the administration of prophylactic tranexamic acid and early use of blood products ( 44 ).…”

Section: The Hematological Systemmentioning

confidence: 99%

Multi-Organ Dysfunction in Cerebral Palsy

Allen

¹

,

Zareen

²

,

Doyle

³

et al. 2021

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Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.

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“… 102 Although not being evaluated as an anticoagulant, hydroxychloroquine and azithromycin, another drug combination that is being explored for the treatment of COVID-19, have also been shown to have anticoagulant properties via alternative mechanisms. 103 104 105 106 107 108 In addition to being used as an antimalarial, hydroxychloroquine has also been used more as a treatment for systemic lupus erythematosus, which poses another potential mechanism by which this combination may have anticoagulant effects during COVID-19. 60 61 62 109 …”

Section: Factor Xa Inhibitors As a Potential Treatment For Covid-19mentioning

confidence: 99%

The Potential Role of Coagulation Factor Xa in the Pathophysiology of COVID-19: A Role for Anticoagulants as Multimodal Therapeutic Agents

Frydman

¹

,

Streiff

²

,

Connors

³

et al. 2020

TH Open

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SARS-CoV-2 infection (COVID-19) results in local and systemic activation of inflammation and coagulation. In this review article, we will discuss the potential role of coagulation factor Xa (FXa) in the pathophysiology of COVID-19. FXa, a serine protease, has been shown to play a role in the cleavage of SARS-CoV-1 spike protein (SP), with the inhibition of FXa resulting in the inhibition of viral infectivity. FX is known to be primarily produced in the liver, but it is also expressed by multiple cells types, including alveolar epithelium, cardiac myocytes, and macrophages. Considering that patients with preexisting conditions, including cardiopulmonary disease, are at an increased risk of severe COVID-19, we discuss the potential role of increased levels of FX in these patients, resulting in a potential increased propensity to have a higher infectious rate and viral load, increased activation of coagulation and inflammation, and development of fibrosis. With these observations in mind, we postulate as to the potential therapeutic role of FXa inhibitors as a prophylactic and therapeutic treatment for high-risk patients with COVID-19.

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“…102 Although not being evaluated as an anticoagulant, hydroxychloroquine and azithromycin, another drug combination that is being explored for the treatment of COVID-19, have also been shown to have anticoagulant properties via alternative mechanisms. [103][104][105][106][107][108] In addition to being used as an antimalarial, hydroxychloroquine has also been used more as a treatment for systemic lupus erythematosus, which poses another potential mechanism by which this combination may have anticoagulant effects during COVID-19. [60][61][62]109 If FXai are confirmed to be effective in the reduction of SP cleavage and cell infectivity, the administration of FXai may also serve as an outpatient treatment for patients who have recently been infected, patients at high risk of exposure, and for patients in the high-risk category by reduction of FXa levels.…”

Section: Factor Xa Inhibitors As a Potential Treatment For Covid-19mentioning

confidence: 99%

Untitled

2020

TH Open

0

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Elevated International Normalized Ratio associated with long-term azithromycin therapy in a child with cerebral palsy

Abstract: An elevated INR in a child with cerebral palsy was evidently related to long-term therapy with azithromycin. The abnormal INR normalized after discontinuation of azithromycin and administration of one dose of phytonadione.

Cited by 6 publications

References 13 publications

Multi-Organ Dysfunction in Cerebral Palsy

Multi-Organ Dysfunction in Cerebral Palsy

The Potential Role of Coagulation Factor Xa in the Pathophysiology of COVID-19: A Role for Anticoagulants as Multimodal Therapeutic Agents

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