Impact of eravacycline on fibrinogen

OBJECTIVES: While tigecycline has been associated with hypofibrinogenaemia, limited data with eravacycline suggest this may also occur with this agent. However, the incidence and clinical significance of this finding are not well defined. METHODS: This is a retrospective cohort study of hospitalized adults who received at least two doses of eravacycline between 1 August 2018 and 1 October 2024 and had two or more fibrinogen levels monitored while on therapy. The primary outcome was ≥50% reduction in fibrinogen while on eravacycline. Secondary outcomes included ≥25% reduction in fibrinogen, time to 50% fibrinogen reduction, development of hypofibrinogenemia (<200 mg/dL) and bleeding events. RESULTS: Thirty-nine patients were included with 17 (44%) being solid organ transplant recipients and 11 (28%) patients not considered to be immunocompromised. Eravacycline was primarily used to treat nontuberculosis mycobacterial infections (82%). The median (IQR) duration of eravacycline therapy was 12 (8-22) days. Thirty-three per cent of patients met the primary outcome of ≥50% decrease in fibrinogen with a median (IQR) time to 50% decrease in fibrinogen of 10 (8-11) days. A substantially higher number, 79%, experienced ≥25% reduction in fibrinogen. Hypofibrinogenaemia developed in 18 (49%) patients. A total of four (10%) patients experienced minor bleeding events. DISCUSSION: A majority of eravacycline-treated patients experienced at least a 25% decrease in fibrinogen levels. Although the decreased fibrinogen levels did not result in major clinically significant bleeding, fibrinogen levels should be monitored at baseline and at least weekly. Patients should also be monitored for any signs and symptoms of bleeding.