Coagulation dysfunction events associated with echinocandins: a real-world study from FDA adverse event reporting system (FAERS) database

Echinocandins belong to the fourth generation of antifungals, and there are no systematic studies on their risk in coagulation dysfunction; this study will predict the risk of coagulation dysfunction of echinocandins using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Data from January 2004 to March 2024 were obtained from FAERS. We examined the clinical characteristics of the coagulation dysfunction events and conducted disproportionality analysis by using reporting odds ratios (ROR) to compare echinocandins with the full database. There were 313 reports of coagulation dysfunction related to echinocandins as the primary suspect (PS) drug. The median time to incident for coagulation dysfunction was 3 (interquartile range [IQR] 1–9) days. Compared to triazoles and polyenes, echinocandins have a stronger signal (ROR 3.18, 95%CI 2.81–3.51, p < 0.01) of coagulation dysfunction. Compared to caspofungin and micafungin, anidulafungin has a stronger signal (ROR 6.84, 95%CI 4.83–9.70, p < 0.01). The strongest signal corresponding to disseminated intravascular coagulation (DIC), platelet count decreased, thrombocytopenia, gastrointestinal haemorrhage, cerebral haemorrhage, pulmonary haemorrhage and thrombotic thrombocytopenic purpura (TTP) is micafungin (ROR 27.19, 95%CI 18.49–39.98), micafungin (ROR 3.50, 95%CI 2.36–5.19), anidulafungin (ROR 9.75, 95%CI 5.22–18.19), micafungin (ROR 3.17, 95%CI 2.02–4.97), micafungin (ROR 4.95, 95%CI 2.81–8.72), caspofungin (ROR 20.76, 95%CI 11.77–36.59), micafungin (ROR 20.43, 95%CI 8.49–49.14), respectively. For coagulation dysfunction, we found stronger signals for echinocandins than triazoles and polyenes, and stronger signals for anidulafungin than micafungin and caspofungin. Coagulation parameters should be closely monitored while using the respective drugs. Real world data were used to predict the risk of coagulopathy for three classes of drugs: echinocandins, triazoles, and polyenes. Real-world data were used to compare the risk of coagulopathy between caspofungin, micafungin, and anidulafungin. Different causes of coagulation dysfunction were analyzed by subgroups.