A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function

Abstract

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.

Tigecycline-induced coagulopathy: a literature review

“…The liver function of the remaining 10 patients was not impaired during tigecycline treatment, but 3 suffered bleeding events [11,15,20], all of whom took the recommended dose. Regarding the retrospective studies, Routsi et al [12] reported that the bilirubin level did not change significantly, while Zhang et al [13] and Leng et al [24] showed that there was no change in alanine aminotransferase (ALT), aspartate aminotransferase, and creatinine (Cr) levels during therapy. However, Sun et al [16] found that 33 of 59 patients had an elevated ALT or total bilirubin level.…”

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

“…They also found that the alterations in FIB, aPTT, and PT started to appear four days after the initial dosage, and they worsened over the following days of treatment. In this study, the changes in the coagulation parameters gradually reversed four days after the discontinuation of treatment [20].…”

Tigecycline Interferes with Fibrinogen Polymerization Independent of Peripheral Interactions with the Coagulation System

“…These minor changes are of little clinical relevance, as clinical overt bleeding in critical care is mostly linked to gross fibrinogen decreases. Moreover, the fibrinogen decrease in critical ill patients tends to occur only after several days of tigecycline start [3,4]. We conclude that the blood of our healthy subjects lacks either the causative agent of the fibrinogen decrease observed in critical ill patients under tigecycline treatment or a long enough exposure to tigecycline.…”

“…A described side effect during tigecycline therapy is coagulopathy. Three small-scale studies reported effects of tigecycline on coagulation [3][4][5]. A clinical trial observed decreased fibrinogen levels as assessed by the classical Clauss method during high-dose treatment with tigecycline in a group of 45 intensive care patients [4].…”

“…Hakeam et al reported decreased fibrinogen levels during tigecycline treatment as compared to imipenem-cilastatin after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with peritoneal carcinomatosis [6]. In a retrospective analysis Leng et al demonstrated decreased fibrinogen levels in 50 hospitalized patients with tigecycline treatment in China [3]. Additionally, eight case reports exist in regard to an effect of tigecycline on coagulation [7][8][9][10][11][12][13][14].…”