A Lesser Known Side Effect of Tigecycline: Hypofibrinogenemia

Yilmaz, Fulya; Yıldırım, Halil İbrahim; Şen, Emre Mehmet

doi:10.4274/tjh.2017.0310

Cited by 23 publications

(16 citation statements)

References 7 publications

(28 reference statements)

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“…[11][12][13] Moreover, a few case reports showed that tigecycline seems to induce coagulation disorders, which manifested through bleeding and abnormal coagulation parameters. [14][15][16][17][18][19][20][21] Therefore, we performed a retrospective analysis to assess the impact of tigecycline treatment on coagulation parameters in 50 patients with bacterial infections admitted to our hospital.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function

Xue

Zhang

et al. 2019

CHEMICAL & PHARMACEUTICAL BULLETIN

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A number of clinical trials demonstrated that tigecycline was effective and well tolerated in the treatment of patients with various bacterial infections, but few literatures had shown the coagulopathy induced by tigecycline. To address this concern, we performed a retrospective analysis to assess the impact of tigecycline treatment on coagulation parameters in 50 patients with bacterial infections in our hospital (Shandong Provincial Hospital, China). These patients were treated with tigecycline at Shandong Provincial Hospital in 2015-2016 at either a recommended (50 mg q12h) or a higher dose (100 mg q12h). Coagulation parameters, including Fibrinogen (FIB) levels, prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLT) and D-dimer, were evaluated in order to assess the impact of tigecycline treatment in these severely infected patients. What we found was that the plasma fibrinogen (FIB) level was 4.63 1.56 g/L before tigecycline treatment, and decreased to 2.92 1.23 g/L during treatment, which was statistically significant (p < 0.001). The mean values of aPTT and PT were significantly increased from 39.58 8.72 to 44.05 10.45 s ( p 0.002), and from 15.37 1.53 to 16.37 2.64 s ( p 0.004), respectively. This study demonstrates that treatment of tigecycline could reduce FIB, prolong aPTT and PT. In conclusion, we advise that it is necessary for practitioners routinely monitor coagulation level in at-rick patient populations treated with tigecycline.

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Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function

Xue

Zhang

et al. 2019

CHEMICAL & PHARMACEUTICAL BULLETIN

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“…Freire et al in 2010 showed a lower therapeutic response for tigecycline than imipenem (using a dosing regimen of 100 mg initially followed by 50 mg every 12 h in a group of ventilated patients), a study often referenced as showing the limited efficacy of tigecycline in this situation [35]. Additionally, the administration of tigecycline treatment has been associated with an increased death rate [5], and a number of case reports have indicated serious complications in patients as a consequence of tigecycline treatment [36][37][38][39][40]. On the other hand, a meta-analysis by Falagas et al in 2014 concluded that high-dose tigecycline regimens may be effective for the treatment of severe bacterial infections [9], and a meta-analysis by Gong et al concluded that high-dose tigecycline regimens did not elevate the risk of toxic side effects [41].…”

Section: Discussionmentioning

confidence: 99%

Successful High-Dosage Monotherapy of Tigecycline in a Multidrug-Resistant Klebsiella pneumoniae Pneumonia–Septicemia Model in Rats

et al. 2020

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Background: Recent scientific reports on the use of high dose tigecycline monotherapy as a “drug of last resort” warrant further research into the use of this regimen for the treatment of severe multidrug-resistant, Gram-negative bacterial infections. In the current study, the therapeutic efficacy of tigecycline monotherapy was investigated and compared to meropenem monotherapy in a newly developed rat model of fatal lobar pneumonia–septicemia. Methods: A Klebsiella pneumoniae producing extended-spectrum β-lactamase (ESBL) and an isogenic variant producing K. pneumoniae carbapenemase (KPC) were used in the study. Both strains were tested for their in vitro antibiotic susceptibility and used to induce pneumonia–septicemia in rats, which was characterized using disease progression parameters. Therapy with tigecycline or meropenem was initiated at the moment that rats suffered from progressive infection and was administered 12-hourly over 10 days. The pharmacokinetics of meropenem were determined in infected rats. Results: In rats with ESBL pneumonia–septicemia, the minimum dosage of meropenem achieving survival of all rats was 25 mg/kg/day. However, in rats with KPC pneumonia–septicemia, this meropenem dosage was unsuccessful. In contrast, all rats with KPC pneumonia–septicemia were successfully cured by administration of high-dose tigecycline monotherapy of 25 mg/kg/day (i.e., the minimum tigecycline dosage achieving 100% survival of rats with ESBL pneumonia–septicemia in a previous study). Conclusions: The current study supports recent literature recommending high-dose tigecycline as a last resort regimen for the treatment of severe multidrug-resistant bacterial infections. The use of ESBL- and KPC-producing K. pneumoniae strains in the current rat model of pneumonia–septicemia enables further investigation, helping provide supporting data for follow-up clinical trials in patients suffering from severe multidrug-resistant bacterial respiratory infections.

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“…In the clinical trials performed, coagulation disorders, such as the prolongation of INR, aPTT, and prothrombin time (PT), were very infrequently (<2%) reported in patients receiving tigecycline treatment though a reduction in fibrinogen levels was not described [11]. After reviewing the literature for cases of hypofibrinogenemia following the use of tigecycline, six case reports were found published in PubMed after the widespread use of tigecycline worldwide [12][13][14][15][16][17]. In all cases, hypofibrinogenemia was reversible and the coagulation disorders resolved within days after stopping the administration of the antibiotic.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Knee Hemarthrosis Due to Hypofibrinogenemia Following Tigecycline Treatment for Periprosthetic Joint Infection

Balfousias

Apostolopoulos

Angelis

et al. 2019

Cureus

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Tigecycline, a recently approved antibiotic, has a broad spectrum of antimicrobial activity. Its unique structure and properties make tigecycline a valuable option for the treatment of infections caused by many multidrug-resistant organisms. We present a case of an 82-year-old patient who developed a significant decrease of fibrinogen levels after the addition of tigecycline to his antibiotic regimen. The patient was treated for a periprosthetic knee joint infection caused by a multidrug-resistant extended-spectrum beta-lactamase-producing Escherichia coli. The reduction of fibrinogen levels, in this case, prompted severe spontaneous hemarthrosis. Tigecycline treatment was discontinued and coagulation disorders were normalized within the next few days. After several days, the joint had to be surgically debrided. Hypofibrinogenemia is a very scarcely reported side effect of tigecycline that can cause spontaneous hemarthrosis.

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A Lesser Known Side Effect of Tigecycline: Hypofibrinogenemia

Cited by 23 publications

References 7 publications

A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function

A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function

Successful High-Dosage Monotherapy of Tigecycline in a Multidrug-Resistant Klebsiella pneumoniae Pneumonia–Septicemia Model in Rats

Spontaneous Knee Hemarthrosis Due to Hypofibrinogenemia Following Tigecycline Treatment for Periprosthetic Joint Infection

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