Tinzaparin is an

antithrombotic An antithrombotic agent is a drug that reduces the formation of blood clots (thrombi).http://cancerweb.ncl.ac.uk/cgi-bin/omd?antithrombotic Antithrombotics can be used therapeutically for prevention (primary prevention, secondary prevention) or tr ...

drug in the

heparin Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Since heparins depend on the activity of antithrombin, they are considered anticoagulants. Specifically it is also used in the treatm ...

group. It is a

low molecular weight heparin Low-molecular-weight heparin (LMWH) is a class of anticoagulant medications. They are used in the prevention of blood clots and treatment of venous thromboembolism (deep vein thrombosis and pulmonary embolism) and in the treatment of myocardial in ...

(LMWH) marketed as Innohep worldwide. It has been approved by the

U.S. Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...

(FDA) for once daily treatment and prophylaxis of

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...

(DVT) and

pulmonary embolism Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...

(PE). It can be given subcutaneously by

syringe A syringe is a simple reciprocating pump consisting of a plunger (though in modern syringes, it is actually a piston) that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside ...

, or

intravenously Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

. It was manufactured by Leo pharmaceutical company, who withdrew the product from the US in 2011 due to low sales and a contamination issue.

Use in elderly

In July 2008, the company revised the prescribing information to restrict the use of tinzaparin in patients 90 years of age or older. FDA is concerned that the preliminary data from the IRIS study suggests that the increased risk of mortality is not limited only to patients 90 years of age or older. According to the study Innohep increases the risk of death for elderly patients (i.e., 70 years of age and older) with

chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...

. Healthcare professionals should consider the use of alternative treatments to Innohep when treating elderly patients over 70 years of age with chronic kidney disease and

, or both.

Use in pregnancy

No LMWH, except tinzaparin, is licensed for use in

gestational hypercoagulability Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis (blood clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent ...

. ''Therapeutic anticoagulation in pregnancy.'' Norfolk and Norwich University Hospital (NHS Trust). Reference number CA3017. 9 June 2006 eview June 2009/ref> Still, tinzaparin is often the LMWH of choice in pregnant women.

Side effects

Bleeding in overdose. There is occasionally bruising at the site of injection.

Monitoring

Tinzaparin does ''not'' affect the international normalized ratio (INR), prothrombin time (PT). Anti-factor Xa levels can be measured, and are often used to monitor tinzaparin.

Reversal agent

Protamine sulfate will reverse Tinzaparin by 85% per package insert.

References

* (22)ESHRE April-2011 volume 33 pages 12–13-14 * e-medicine 2011 * RCOG March-2010 (Royal college for Obestetric and Gynecology) * DVT.org/cardiologist * Hull, New England Journal of Medicine, 2010 volume 22 page 19

External links

* * {{Antithrombotics Heparins