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Wen X, Cai L, Gao A, Fu A, Guo D, Zhu M. Pharmacovigilance analysis of drug-induced hypofibrinogenemia using the FDA Adverse Event Reporting System. Int J Clin Pharm 2025:10.1007/s11096-025-01867-6. [PMID: 39888490 DOI: 10.1007/s11096-025-01867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 01/04/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Drug-induced hypofibrinogenemia has received increasing scrutiny; however, the specific drugs involved remain poorly characterized. Hypofibrinogenemia can have significant clinical implications, including increased bleeding risks. AIM This study aimed to utilize the FDA Adverse Event Reporting System (FAERS) to identify and analyze drugs frequently implicated in drug-induced hypofibrinogenemia. METHOD A disproportionality analysis was conducted using FAERS data from January 2004 to March 2024. Various statistical tools were used, including the Reporting Odds Ratio (ROR), Proportional Reporting Ratio, Medicines and Healthcare Products Regulatory Agency metrics, and Bayesian confidence propagation neural network. RESULTS The analysis included 17,627,340 cases involving 52,373,206 adverse events, with 1,661 cases identified as hypofibrinogenemia. The top five drugs associated with hypofibrinogenemia by case number were methotrexate (124 cases), tigecycline (119 cases), tocilizumab (100 cases), pegaspargase (83 cases), and alteplase (57 cases). The drugs ranked by signal strength based on ROR included eravacycline (ROR 2173.84, 95% CI 1208.80-3909.30), tigecycline (ROR 747.34, 95% CI 619.03-902.24), crotalidae polyvalent immune Fab (ROR 407.67, 95% CI 291.07-570.99), pegaspargase (ROR 216.06, 95% CI 173.15-269.61), and asparaginase (ROR 184.93, 95% CI 132.18-258.72). CONCLUSION This analysis of FAERS data identified 52 drugs associated with hypofibrinogenemia, most (88.5%) of which do not mention this risk in their prescribing information. These findings demonstrate the need for the monitoring of blood fibrinogen and may serve as a reference for the explore of the characteristics and underlying mechanism of drug-induced hypofibrinogenemia in the real world.
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Affiliation(s)
- Xiao Wen
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Le Cai
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Ao Gao
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - An Fu
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Daihong Guo
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Man Zhu
- Department of Pharmacy, Medical Supplies Center of Chinese, PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China.
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Cai L, Wen X, Qiu Z, Fu A, Guo D, Zhu M. Characteristics, risk factors and a risk prediction model of tocilizumab-induced hypofibrinogenemia: a retrospective real-world study of inpatients. BMC Pharmacol Toxicol 2025; 26:5. [PMID: 39789607 PMCID: PMC11721054 DOI: 10.1186/s40360-024-00827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/17/2024] [Indexed: 01/12/2025] Open
Abstract
OBJECTIVE The occurrence of hypofibrinogenemia after tocilizumab treatment has attracted increasing attention, which may cause bleeding and even life-threatening. This study aims to explore the risk factors for tocilizumab-induced hypofibrinogenemia (T-HFIB) and construct a risk prediction model. METHODS A total of 221 inpatients that received tocilizumab from 2015 to 2023 were retrospectively collected and divided into T-HFIB group or control group. The risk factors for T-HFIB were obtained by logistic regression equation and used to establish the nomogram. RESULTS T-HFIB was observed in 121 of 221 patients (54.75%). Multifactorial logistic regression analysis revealed that infection (OR = 2.002, 95%CI:1.018 ~ 3.935), COVID-19 (OR = 3.752, 95%CI:1.264 ~ 11.139), CAR-T therapy (OR = 4.409, 95%CI:2.017 ~ 0.894), and concomitant glucocorticoids (OR = 5.303, 95%CI:0.227 ~ 0.894) were identified as independent risk factors for T-HFIB, while high baseline fibrinogen level (OR = 0.813, 95%CI:0.670 ~ 0.988) and concomitant antirheumatic drugs (OR = 0.451, 95%CI:0.227 ~ 0.894) were identified as protective factors. A nomogram was established, and area under the curve (AUC) of prediction model was 0.772 (95%CI:0.709 ~ 0.836). Calibration curve showed a good prediction accuracy for the occurrence of T-HFIB. CONCLUSION The infection, COVID-19, CAR-T therapy, and concomitant glucocorticoids were independent risk factors for T-HFIB, while high baseline fibrinogen and concomitant antirheumatic drugs were protective factors. This nomogram can help early identify the patients at potential high risk of developing T-HFIB.
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Affiliation(s)
- Le Cai
- Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Xiao Wen
- Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Zihan Qiu
- School of Pharmacy, Tian Jin Medical University, Tianjin, 300070, China
| | - An Fu
- Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Daihong Guo
- Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China
| | - Man Zhu
- Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China.
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Li M, He J, Dong G, Hu L, Shao H. Serum concentration threshold and risk factors of tigecycline-induced hypofibrinogenaemia in critically ill patients. J Antimicrob Chemother 2025; 80:200-208. [PMID: 39508368 DOI: 10.1093/jac/dkae396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/18/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVES Hypofibrinogenaemia is a serious adverse reaction associated with tigecycline (TGC) therapy and may lead to the discontinuation of the treatment. This study aimed to explore the relevant factors of TGC-induced hypofibrinogenaemia and determine the thresholds of serum concentration as a predictive indicator of TGC-induced hypofibrinogenaemia. METHODS A retrospective single-centre study was conducted on patients with severe infection who were treated with TGC. Clinical data and serum concentration parameters were extracted from the electronic medical records of these patients. Patients were divided into the hypofibrinogenaemia group (< 2.0 g/L) and the normal fibrinogen group (≥ 2.0 g/L) in order to evaluate risk factors associated with TGC-induced hypofibrinogenaemia. Logistic regression analysis and receiver operating characteristic curves were utilized to identify the risk factors associated with TGC-induced hypofibrinogenaemia and to establish plasma concentration thresholds as predictive indicators. RESULTS A total of 114 patients were enrolled in this study, with 59.6% experiencing hypofibrinogenaemia. The multivariate regression analysis indicated that baseline fibrinogen level, trough concentration (Cmin), peak concentration (Cmax), the concentration at 6 h after the dosing (C6h) and the area under the concentration-time curve over a 24-h period (AUC0-24) were significantly associated with hypofibrinogenaemia (P < 0.05). Furthermore, it was found that AUC0-24 is the optimal predictor of TGC-induced hypofibrinogenaemia. The optimal cut-off for the AUC0-24 of TGC in ICU patients was determined to be 17.03 mg h/L. CONCLUSIONS TGC exposure is highly predictive of TGC-induced hypofibrinogenaemia. We recommend closely monitoring plasma concentrations of TGC in patients to ensure patient efficacy and safety.
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Affiliation(s)
- Mengxue Li
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Jie He
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Gaoqiu Dong
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Linlin Hu
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, China
- Office of Clinical Trial Institution, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Hua Shao
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, China
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Sun H, Meng X, Shao X, Duan L, Fan K. Impact of Tigecycline on Coagulation in Severe Infections and Effect of Vitamin K1 Intervention: A Retrospective Single-Center Analysis. Med Sci Monit 2024; 30:e944778. [PMID: 39488729 PMCID: PMC11542504 DOI: 10.12659/msm.944778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 08/29/2024] [Indexed: 11/04/2024] Open
Abstract
BACKGROUND Tigecycline is a tetracycline antibiotic used to treat gram-positive and gram-negative bacterial infections, and bleeding is a dose-dependent adverse effect. Vitamin K1 is a fat-soluble vitamin used to treat hemorrhagic conditions. This retrospective study from a single center included 920 patients treated with tigecycline for bacterial infections between January 2017 and December 2022 and aimed to evaluate the incidence of coagulopathy and the use of vitamin K1. MATERIAL AND METHODS A total of 220 patients were included and divided into a high-dose group (100 mg, every 12 h) and normal-dose group (50 mg, every 12 h) according to the treatment dose of tigecycline. Clinical characteristics and changes in coagulation indicators during tigecycline treatment were collected. Seventy-two patients were treated with vitamin K1, and the changes in coagulation indicators before and after treatment were compared. ANOVA and t test were used to analyze the effects of different doses of tigecycline on coagulation function and the intervention of vitamin K1. RESULTS Among 920 patients, the incidence of coagulopathy was 23.91%. In both groups, coagulopathy occurred on days 5 to 7 after administration, and the high-dose group had worse coagulation function than the normal-dose group, including activated partial thrombin time, prothrombin time, and fibrinogen (P<0.05). After treatment with vitamin K1, fibrinogen increased and activated partial thrombin time and prothrombin time were shortened in both groups (P<0.05 or P<0.01). CONCLUSIONS Tigecycline caused coagulopathy with dose and time dependence. Vitamin K1 can improve tigecycline-induced coagulopathy.
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Affiliation(s)
- Haiyan Sun
- Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Xianqing Meng
- Department of Infectious Diseases, Affiliated Hospital of Shandong University, of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Xupeng Shao
- Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Liyun Duan
- Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Kailiang Fan
- Department of Emergency Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
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Ma C, Ren X, Pang N, Liu Y, Chen M, Zhang X, Liu Y, Huang L. Incidence, characteristics, and risk factors of hypofibrinogenemia induced by generic tigecycline: a retrospective study. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03419-7. [PMID: 39254879 DOI: 10.1007/s00210-024-03419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024]
Abstract
The objective of this study was to evaluate the incidence, clinical features, and risk factors of generic tigecycline-associated hypofibrinogenemia. A single-center retrospective study was conducted in adult patients treated with generic tigecycline. Clinical data were extracted from the electronic medical records. The endpoint was tigecycline-related hypofibrinogenemia, defined as a condition with no abnormality in fibrinogen before tigecycline application, but developing hypofibrinogenemia upon prescription. The risk factors were determined by logistic regression analysis, and the ROC curve was subsequently established. A total of 240 adults prescribed generic tigecycline from May 1st to November 30th 2023 were included. It was shown that hypofibrinogenemia is a frequent side effect of generic tigecycline, with an adverse reaction rate of 42.9% (103/240). However, the incidence of adverse reactions to generic drugs was lower than in previous studies. The cumulative dose of tigecycline (OR:1.002, 95%CI 1.001-1.002, P < 0.001), baseline FIB (OR:0.995, 95%CI 0.992-0.997, P < 0.001), baseline PT (OR:1.247, 95%CI 1.071-1.452, P = 0.004) and baseline ALB (OR:0.931, 95%CI 0.879-0.986, P = 0.025) were identified as independent prognostic factors of tigecycline-related hypofibrinogenemia. We recommend intensive monitoring of coagulation function in patients exhibiting the aforementioned risk factors for generic tigecycline-associated hypofibrinogenemia to ensure patients safety.
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Affiliation(s)
- Chaoqun Ma
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
- Department of Pharmacy, Beijing Miyun District Traditional Chinese Medicine Hospital, Beijing, China
| | - Xiaolei Ren
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Ning Pang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Yingkun Liu
- Department of Pharmacy, Affiliated Hospital of Chifeng College, Nei Mongol, China
| | - Meifang Chen
- Department of Infectious Disease, Peking University People's Hospital, Beijing, China
| | - Xiaohong Zhang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Yi Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China.
| | - Lin Huang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China.
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Zhang X, Pan J, Zhang X, Yang Q, Li Z, Liu F. Safety profiles of tetracycline-class drugs: a pharmacovigilance analysis of the FAERS database. Expert Opin Drug Saf 2024:1-10. [PMID: 39158402 DOI: 10.1080/14740338.2024.2393276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND As synthesis technology advances, novel and efficient derivatives of tetracyclines are found. Three new antibiotics were approved within the past 18 years, and represent a new era in the use of tetracyclines. To gain further insight into adverse events linked to tetracyclines and better protect pediatric patients, ongoing monitoring of safety data is crucial. METHODS The FAERS data from the first quarter of 2004 to the third quarter of 2023 in the AERSMine were extracted to conduct disproportionality analysis. The association between five tetracyclines and adverse events was evaluated using reporting odds ratio, and their risk factors were explored by multivariate logistic regression analysis. RESULTS Our study showed that thyroid gland disorders had the strongest signal in children. Patients aged 12-18 and treatment with minocycline are risk factors for thyroid adverse events (12-18: OR = 10.727 [7.113-16.177], p < 0.0001; minocycline: OR = 17.025 [10.475-27.678], p < 0.0001). Second-generation tetracycline and third-generation tetracycline ADR patterns differed. Blood fibrinogen decreased and hypofibrinogenaemia was primarily reported with tigecycline and eravacycline. CONCLUSION This study provided basic evidence for further research on tetracyclines-related adverse events. However, the safety of third-generation tetracycline in children requires additional validation through a large-scale prospective study.
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Affiliation(s)
- Xu Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Juan Pan
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Xiaojuan Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Qiongliang Yang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Zuyi Li
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Furong Liu
- Institute of Clinical Pharmacy, Department of Pharmacy, The Affiliated Nanhua Hospital, Hengyang Medical School, Hengyang, China
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Firat O, Kara E, Malkan ÜY, Demirkan K, Inkaya AÇ. Tigecycline-associated hypofibrinogenemia: A single center, retrospective, controlled study. Thromb Res 2024; 236:155-160. [PMID: 38452447 DOI: 10.1016/j.thromres.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Tigecycline-associated hypofibrinogenemia has been reported as an important adverse effect in recent years, but controlled studies minimizing confounding factors are needed. The objective of our study was to assess changes in fibrinogen levels in patients for hospitalization, comparing two antibiotic episodes (tigecycline and other) within the same patients. METHODS The retrospective, self-controlled case series study was conducted at our University Hospitals. The study compared the change in fibrinogen levels during the patient's hospitalization for tigecycline (TigePer) and another antibiotic period (OtherPer). In addition, bleeding events, bleeding risk (determined by the IMPROVE bleeding risk score), as well as 15- and 30-day mortality rates between TigePer and OtherPer were compared. RESULTS The study enrolled 50 patients with 100 episodes of antibiotic treatment. The median age (interquartile range) of the patients was 68.5 (21.5) years, and 38 % were female. As compared to OtherPer, TigePer had a statistically significant reduction in fibrinogen levels (p < 0.001), with a hypofibrinogenemia rate of 40 % in TigePer as compared to 2 % in OtherPer (p < 0.001). TigePer demonstrated a significantly higher 15-day mortality rate (p = 0.006). No significant differences were observed between the two periods in terms of bleeding risk, rate of bleeding events, and 30-day mortality rate (p > 0.05). CONCLUSION Hypofibrinogenemia and other coagulopathies, without associated bleeding events, are more frequently observed in patients receiving tigecycline. Therefore, it is crucial for clinicians to monitor fibrinogen levels during tigecycline use.
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Affiliation(s)
- Oğuzhan Firat
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye.
| | - Emre Kara
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Diseases, Hematology Subdivision, Ankara, Turkiye
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye.
| | - Ahmet Çağkan Inkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkiye
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Guo J, Wang S, Zhou M, Cao J, Cai X, Zhang W, Zhao W, Zhang F, Tian S, Qian X, Zhang J, Li B. Nomogram for the prediction of tigecycline-induced hypofibrinogenaemia in a Chinese population. Int J Antimicrob Agents 2024; 63:107062. [PMID: 38104947 DOI: 10.1016/j.ijantimicag.2023.107062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Tigecycline has been widely used for multi-drug-resistant bacterial infections in China. Although many studies have reported the risk factors for tigecycline-induced hypofibrinogenaemia, it remains unknown whether valproic acid or voriconazole in combination with tigecycline is associated with the decrease in fibrinogen, as both drugs could lead to coagulation disorders. The aim of this study was to develop a nomogram for the prediction of tigecycline-induced hypofibrinogenaemia. METHODS This was a multi-centre retrospective case-control study. The primary outcome was the accurate prediction of tigecycline-induced hypofibrinogenaemia. Nomograms were developed from logistic regression models with least absolute shrinkage and selection operator regression for variable selection. Model performance was assessed via calibration plots, and models were validated internally using bootstrapping on a validation cohort. RESULTS In total, 2362 patients were screened, of which 611 were eligible for inclusion in this study. These 611 patients were divided into the training cohort (n=488) and the validation cohort (n=123). Predictors included in the nomogram for the total population were total dose, age, fibrinogen, prothrombin time (PT), comorbidity, and concomitant use of voriconazole. Total dose, fibrinogen, PT, activated partial thromboplastin time, white blood cell count, and concomitant use of voriconazole were selected to predict hypofibrinogenaemia in patients with malignant haematologic diseases. Both models were calibrated adequately, and their predictions were correlated with the observed outcome. The cut-offs for treatment duration in the total population and the subgroup were 10 and 6 days, respectively. CONCLUSIONS Tigecycline in combination with voriconazole could increase the risk of hypofibrinogenaemia, and tigecycline-induced hypofibrinogenaemia is more likely to occur in patients with malignant haematologic diseases.
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Affiliation(s)
- Jinlin Guo
- Department of Pharmacy, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Shan Wang
- Department of Pharmacy, NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Mi Zhou
- Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jianghong Cao
- Department of Intensive Care Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Xinfeng Cai
- Department of Pharmacy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated with Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated with Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Wenjun Zhang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wei Zhao
- Department of Pharmacy, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fang Zhang
- Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shuangshuang Tian
- Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xin Qian
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jingmin Zhang
- Department of Pharmacy, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Binbin Li
- School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, China
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Zhang L, Cai X, Peng F, Tian S, Wu X, Li Y, Guo J. Comparison of bleeding risk and hypofibrinogenemia-associated risk factors between tigecycline with cefoperazone/sulbactam therapy and other tigecycline-based combination therapies. Front Pharmacol 2023; 14:1182644. [PMID: 37351509 PMCID: PMC10282135 DOI: 10.3389/fphar.2023.1182644] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
Background: Tigecycline and cefoperazone/sulbactam can cause coagulation disorders; tigecycline may also lead to hypofibrinogenemia, raising safety concerns. This study aimed to investigate whether tigecycline plus cefoperazone/sulbactam increases the risk of bleeding compared with other tigecycline-based combination therapies and identify risk factors for tigecycline-associated hypofibrinogenemia. Methods: In this multi-method, multicenter, retrospective study, coagulation and other baseline variables were compared using a cohort study, and risk factors for hypofibrinogenemia using a case-control study. Results: The 451 enrolled participants were divided into three group: tigecycline plus cefoperazone/sulbactam (Group A, 193 patients), tigecycline plus carbapenems (Group B, 200 patients) and tigecycline plus β-lactams without N-methylthio-tetrazole (NMTT) side chains (Group C, 58 patients). Activated partial thromboplastin time and prothrombin time were prolonged, and fibrinogen declined for all patients after tigecycline-based medication (all p < 0.05). Prothrombin time in Group B was significantly longer than in other groups (p < 0.05), but there were no significant differences in bleeding events between the three groups (p = 0.845). Age greater than 80 years (OR: 2.85, 95% CI: 1.07-7.60), treatment duration (OR: 1.29, 95% CI: 1.19-1.41), daily dose (OR: 2.6, 95% CI: 1.29-5.25), total bilirubin (OR: 1.01, 95% CI: 1.01-1.02) and basal fibrinogen (OR: 1.32, 95% CI: 1.14-1.63) were independent risk factors of hypofibrinogenemia. The optimal cut-off for treatment course was 6 days for high-dose and 11 days for low-dose. Conclusion: Tigecycline plus cefoperazone/sulbactam did not increase the risk of bleeding compared with tigecycline plus carbapenem, or tigecycline plus β-lactam antibiotics without NMTT-side-chains. Coagulation function should be closely monitored in patients receiving tigecycline treatment.
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Affiliation(s)
- Lei Zhang
- Department of Pharmacy, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Xinfeng Cai
- Department of Pharmacy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Fangchen Peng
- Department of Pharmacy, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Shuangshuang Tian
- Department of Nephrology, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Xinjing Wu
- Department of Pharmacy, Yuncheng Central Hospital, Yuncheng, China
| | - Yun Li
- Department of Pharmacy, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Jinlin Guo
- Department of Pharmacy, Shanxi Provincial People’s Hospital, Taiyuan, China
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