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

Brandtner, Anna; Bachler, Mirjam; Fries, Dietmar; Hermann, Martin; Ruehlicke, Jacqueline; Fux, Vilmos; Griesmacher, Andrea; Niederwanger, Christian; Hell, Tobias; Treml, Benedikt

doi:10.3390/antibiotics9020084

Cited by 13 publications

(13 citation statements)

References 30 publications

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“…However, the addition of supra-therapeutic tigecycline to the cell culture fluid in vitro significantly reduced the viability of hepatocytes. 32 It is speculated that tigecycline may inhibit the liver’s synthetic function.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Tigecycline-Associated Hypofibrinogenemia

Liu

Yan

Zhang

2021

TCRM

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Background With the widespread use of tigecycline, especially in elderly people infected with multidrug-resistant bacteria, the associated coagulation disorders are attracting the attention of clinicians. The risk factors of tigecycline-associated hypofibrinogenemia are still controversial. Purpose The aims of our study were to explore the related factors of hypofibrinogenemia caused by tigecycline, and to establish the risk assessment criteria for tigecycline-associated hypofibrinogenemia. Patients and Methods This was an observational retrospective cohort study of patients treated for at least 3 days with tigecycline. Hypofibrinogenemia was defined as plasma fibrinogen <2.0 g/L. Risk factors were determined using logistic regression analysis, and the risk assessment criteria were identified by using receiver operating characteristic curves. Results In total, 148 patients were included in the analysis, mean age was 77.09±15.11 years old. Ninety patients who developed hypofibrinogenemia during tigecycline treatment with mean plasma fibrinogen of 1.42 g/L were included in the hypofibrinogenemia group, the other 58 patients with mean plasma fibrinogen of 2.68 g/L were included in the normal group. In the multivariate analysis, age ( p = 0.035), tigecycline treatment duration ( p = 0.044), and baseline fibrinogen level ( p = 0.002) were independently associated with hypofibrinogenemia. An age of ≥82 years, ≥9 days of medication, and a baseline fibrinogen level of ≤3.5 g/L were selected for predicting hypofibrinogenemia. Hypofibrinogenemia was independently associated with bleeding (OR 8.96, 95% CI [1.132–70.946], p = 0.038). Conclusion Hypofibrinogenemia is a common adverse effect of tigecycline in our study. Elderly patients are more prone to developing hypofibrinogenemia after the administration of tigecycline. It is independently associated with bleeding but not death. The risk assessment criteria can help in the identification of patients with high risk of hypofibrinogenemia.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Tigecycline-Associated Hypofibrinogenemia

Liu

Yan

Zhang

2021

TCRM

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“…Our group showed qualitative changes in the architecture of the fibrin network with increasing doses of tigecycline in vitro, without observing an effect on clot stability. Therefore, peripheral interactions of tigecycline on fibrin polymerization are not the reason for such coagulopathy [51]. None of the previously mentioned mechanisms can completely explain the coagulopathy related to the tigecycline use, and further studies could still shed light on this issue.…”

Section: Mechanism Of Coagulopathymentioning

confidence: 92%

Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

Treml

Bukumirić

Hell

et al. 2021

JCM

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Tigecycline is a novel glycylcycline broad-spectrum antibiotic offering good coverage for critically ill patients experiencing complicated infections. A known side effect is a coagulation disorder with distinct hypofibrinogenemia. To date, the information on possible risk factors and outcomes is sparse. Therefore, the aim of this study is to examine the time course of fibrinogen level changes during tigecycline therapy in critically ill patients. Moreover, we sought to identify risk factors for coagulopathy and to report on clinically important outcomes. We retrospectively reviewed all intensive care patients admitted to our General and Surgical Intensive Care Unit receiving tigecycline between 2010 and 2018. A total of 130 patients were stratified into two groups based on the extent of fibrinogen decrease. Patients with a greater fibrinogen decrease received a higher dose, a longer treatment and more dose changes of tigecycline, respectively. In regard to the underlying pathology, these patients showed higher inflammation markers as well as a slightly reduced liver synthesis capacity. We, therefore, conclude that such a fibrinogen decrease may be based upon further impairment of liver synthesis during severe inflammatory states. To decrease the risk of bleeding, cautious monitoring of coagulation in critically ill patients treated with high-dose tigecycline is warranted.

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“…Examples were either piperacillin-tazobactam or a carbapenem, combined with teicoplanin or linezolid. We did use tigecycline in 1 patient, although one needs to monitor fibrinogen levels after a few days of treatment [5].…”

Section: Resultsmentioning

confidence: 99%

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm

Baraboutis

Gargalianos

Aggelonidou

et al. 2020

SN Compr. Clin. Med.

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We report our initial experience with the management of a mixed group of patients with COVID-19 infection, admitted and treated in a designated COVID-19 centre in the Athens Metropolitan area over a 4-week period. The SARS-CoV-2 pandemic presented a huge challenge to the Greek National Healthcare System and healthcare workers. Their response so far has been miraculously effective. Since there are essentially no therapeutic guidelines yet for this disease, we relied mainly on our medical intuition, our empathy for our patients and team work to do the best possible for 49 people with this infection. We present the therapeutic algorithm we gradually developed (on the job) and applied in our patients, based on continuous creative brainstorming and monitoring of the literature. Keywords COVID-19 infection. Coinfections. Bovine coronavirus. Ferritin. C-reactive protein. D-dimer. Viral replication. Human immunodeficiency virus (HIV). Pneumocystis jiroveci pneumonia. Oral candidiasis. Adult respiratory distress syndrome. Cytokine release syndrome. Immunomodulatory therapy. Interleukin-6. Interleukin-1. Soluble urokinase-type plasminogen activator receptor. Antimicrobial therapy. Corticosteroids. Lung microbiota This article is part of the Topical Collection on COVID-19

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

Cited by 13 publications

References 30 publications

Risk Factors for Tigecycline-Associated Hypofibrinogenemia

Risk Factors for Tigecycline-Associated Hypofibrinogenemia

Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

Initial Real-Life Experience from a Designated COVID-19 Centre in Athens, Greece: a Proposed Therapeutic Algorithm

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