Abstract：
Purpose: To describe a case of significantly elevated international normalized ratio (INR) in a patient on apixaban receiving treatment with intravenous cefazolin in the setting of coronavirus disease 2019 (COVID-19) infection and malnutrition. Summary: A 74-year-old male patient on apixaban receiving cefazolin for osteomyelitis in the setting of COVID-19 and poor nutritional intake presented with internal jugular tunneled catheter site bleeding and an INR of greater than 22.5. Laboratory abnormalities and bleeding concerns were successfully managed with vitamin K and changing antimicrobial therapy from cefazolin to daptomycin. Follow-up labs one week later demonstrated a sustained improvement in coagulopathy. Conclusion: INR prolongation believed to be secondary to cefazolin can be effectively managed with administration of vitamin K and conversion of antimicrobial therapy to an alternative agent.
摘要：
目的：描述一例因2019年冠状病毒病（COVID-19）感染和营养不良而接受阿哌沙班静脉注射头孢唑林治疗的患者的国际标准化比率（INR）显着升高的病例。
结论：一名服用阿哌沙班的74岁男性患者在COVID-19环境下接受头孢唑林治疗骨髓炎，营养摄入不足，表现为颈静脉内隧道导管部位出血，INR大于22.5。使用维生素K并将抗菌疗法从头孢唑林改为达托霉素，成功地治疗了实验室异常和出血问题。一周后的随访实验室显示凝血障碍持续改善。
结论：认为头孢唑林继发的INR延长可以通过服用维生素K和将抗菌疗法转换为替代药物来有效管理。
结论：一名服用阿哌沙班的74岁男性患者在COVID-19环境下接受头孢唑林治疗骨髓炎，营养摄入不足，表现为颈静脉内隧道导管部位出血，INR大于22.5。使用维生素K并将抗菌疗法从头孢唑林改为达托霉素，成功地治疗了实验室异常和出血问题。一周后的随访实验室显示凝血障碍持续改善。
结论：认为头孢唑林继发的INR延长可以通过服用维生素K和将抗菌疗法转换为替代药物来有效管理。
