Formulary
Tinzaparin sodium: Indications, Dosing, Side Effects and Interactions
Tinzaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated...
MedNext Academy | 4 min read
Tinzaparin sodium: Indications, Dosing, Side Effects and Interactions
Tinzaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated...
Drug action
Tinzaparin sodium is a low molecular weight heparin that acts as an anticoagulant by enhancing the effect of antithrombin III to primarily inhibit activated factor X (factor Xa), with a lesser effect on thrombin.
Indications and dose
**Prophylaxis of deep-vein thrombosis (general surgery)**
- **Adult** (By Subcutaneous Injection): 3500 units for 1 dose, dose to be given 2 hours before surgery, then 3500 units every 24 hours.
**Prophylaxis of deep-vein thrombosis (orthopaedic surgery)**
- **Adult** (By Subcutaneous Injection): Initially 50 units/kg for 1 dose, dose to be given 2 hours before surgery, then 50 units/kg every 24 hours, alternatively initially 4500 units for 1 dose, dose to be given 12 hours before surgery, then 4500 units every 24 hours.
**Extended treatment of venous thromboembolism and prevention of recurrence in patients with active cancer**
- **Adult** (By Subcutaneous Injection): 175 units/kg once daily for 6 months, the benefit of continued treatment beyond 6 months should be evaluated.
**Treatment of deep-vein thrombosis,Treatment of pulmonary embolism**
- **Adult** (By Subcutaneous Injection): 175 units/kg once daily until adequate oral anticoagulation established, treatment regimens do not require anticoagulation monitoring.
**Treatment of venous thromboembolism in pregnancy**
- **Adult** (By Subcutaneous Injection): 175 units/kg once daily, dose based on early pregnancy body-weight, treatment regimens do not require anticoagulation monitoring.
**Treatment of thrombotic episodes for tinzaparin sodium**
- **Child 1 month** (By subcutaneous injection): 275 units/kg once daily.
- **Child 2-11 months** (By subcutaneous injection): 250 units/kg once daily.
- **Child 1-4 years** (By subcutaneous injection): 240 units/kg once daily.
- **Child 5-9 years** (By subcutaneous injection): 200 units/kg once daily.
- **Child 10-17 years** (By subcutaneous injection): 175 units/kg once daily.
**Treatment of venous thromboembolism in pregnancy for tinzaparin sodium**
- **Child 12-17 years** (By subcutaneous injection): 175 units/kg once daily, dose based on early pregnancy body-weight.
**Prophylaxis of thrombotic episodes for tinzaparin sodium**
- **Child** (By subcutaneous injection): 50 units/kg once daily.
Cautions
Elderly; risk of bleeding; severe hypertension
Contraindications
Acute bacterial endocarditis; after major trauma; avoid injections containing benzyl alcohol in neonates; epidural anaesthesia with treatment doses; haemophilia or other haemorrhagic disorders; peptic ulcer; recent cerebral haemorrhage; recent surgery to eye; recent surgery to nervous system; spinal anaesthesia with treatment doses; thrombocytopenia (including history of heparin-induced thrombocytopenia) Contra-indications For tinzaparin sodium Mechanical prosthetic heart valve
Side effects
Common or very common Haemorrhage; heparin-induced thrombocytopenia; skin reactions Rare or very rare Alopecia; hyperkalaemia; osteoporosis (following long term use); spinal haematoma Side-effects, further information Haemorrhage If haemorrhage occurs it is usually sufficient to withdraw heparin or a low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulfate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Heparin-induced thrombocytopenia Clinically important heparin-induced thrombocytopenia is immune-mediated and can be complicated by thrombosis. Signs of heparin-induced thrombocytopenia include a 30% reduction of platelet count, thrombosis, or skin allergy. If heparin-induced thrombocytopenia is strongly suspected or confirmed, the heparin should be stopped and an alternative anticoagulant, such as danaparoid, should be given. Ensure platelet counts return to normal range in those who require warfarin. Hyperkalaemia Inhibition of aldosterone secretion by heparin or a low molecular weight heparin can result in hyperkalaemia; patients with diabetes mellitus, chronic renal failure, acidosis, raised plasma potassium or those taking potassium-sparing drugs seem to be more susceptible. The risk appears to increase with duration of therapy. Side-effects For tinzaparin sodium Common or very common Anaemia Rare or very rare Angioedema; priapism; Stevens-Johnson syndrome; thrombocytosis
Pregnancy
Treatment of venous thromboembolism in pregnancy for Innohep 20,000 units/mL By subcutaneous injection Adult 175 units/kg once daily, dose based on early pregnancy body-weight, treatment regimens do not require anticoagulation monitoring.
Breast feeding
Due to the relatively high molecular weight of tinzaparin and inactivation in the gastro-intestinal tract, passage into breast-milk and absorption by the nursing infant are likely to be negligible; however manufacturer advise avoid.
Renal impairment
Risk of bleeding may be increased. Heparin may be preferable. Manufacturer advises caution if eGFR less than 30 mL/minute/1.73 m 2 . Monitoring In renal impairment monitoring of anti-Factor Xa may be required if eGFR less than 30 mL/minute/1.73 m 2 .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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