Supplementary Material for: Safety of Tigecycline in Patients on Antithrombotic Therapy: A Single Center Retrospective Study

Introduction: To investigate the risk factors of tigecycline-induced hypofibrinogenemia, and to evaluate the safety of tigecycline with concomitant antithrombotic drugs. Methods: We performed a retrospective analysis of patients who received tigecycline for more than 3 days between January 2015 and June 2019. Clinical and laboratory data were collected including fibrinogen concertation, tigecycline dose, duration of treatment, disease severity, complete blood count, indicators of infection, liver and renal function. Risk factors of hypofibrinogenemia were analyzed by univariate and multivariate analysis. To evaluate the safety of tigecycline and concomitant antithrombotic drugs, bleeding events were assessed by comparing the decline in hemoglobin and the amount of red blood cell transfusion in patients with antithrombotic drugs and those without. Results: This study included a total of 68 cases, 20 of which experienced hypofibrinogenemia while receiving tigecycline treatment. Duration of treatment, cefoperazone/sulbactam combination therapy, and fibrinogen levels prior to initiation of tigecycline were risk factors associated with tigecycline-induced hypofibrinogenemia. There were 26 recorded bleeding incidents, 25 of which happened before the start of tigecycline. Antithrombotic and non-antithrombotic patients did not differ in their hemoglobin decline or need for red blood cell transfusions while taking tigecycline. Conclusion: A longer treatment duration, cefoperazone/sulbactam combination therapy, and a lower level of fibrinogen level before tigecycline were associated with an increased risk of tigecycline induced hypofibrinogenemia. A combination of antithrombotic drugs and tigecycline did not aggravate the bleeding events during tigecycline treatment.

引言：本研究旨在探讨替加环素（tigecycline）诱导的低纤维蛋白原血症（hypofibrinogenemia）的危险因素，并评估替加环素联合抗血栓药物（antithrombotic drugs）的安全性。方法：本研究对2015年1月至2019年6月期间接受替加环素治疗≥3天的患者开展回顾性分析，收集患者的临床与实验室检测数据，包括纤维蛋白原浓度、替加环素给药剂量、治疗时长、疾病严重程度、血常规、感染指标、肝肾功能。通过单因素与多因素分析，明确低纤维蛋白原血症的危险因素。为评估替加环素联合抗血栓药物的安全性，本研究对比了使用抗血栓药物与未使用该类药物的患者在治疗期间的血红蛋白下降幅度及红细胞输注量，以评估出血事件发生情况。结果：本研究共纳入68例患者，其中20例在接受替加环素治疗期间出现低纤维蛋白原血症。治疗时长、头孢哌酮舒巴坦（cefoperazone/sulbactam）联合用药方案，以及替加环素治疗前的纤维蛋白原水平，均为替加环素诱导低纤维蛋白原血症的相关危险因素。本研究共记录26例出血事件，其中25例发生于替加环素治疗启动前。使用抗血栓药物的患者与未使用者相比，治疗期间的血红蛋白下降幅度及红细胞输注需求均无显著差异。结论：更长的治疗时长、头孢哌酮舒巴坦联合用药，以及替加环素治疗前更低的纤维蛋白原水平，均会增加替加环素诱导低纤维蛋白原血症的发生风险。替加环素与抗血栓药物联合使用，不会加重治疗期间的出血事件。