Tinzaparin for venous thromboembolism in patients with renal impairment: a single-centre, prospective pilot study.

Abstract

BACKGROUND:

Low molecular weight heparins (LMWH) are used extensively for prophylaxis and treatment of venous thromboembolism (VTE), bridging therapy for warfarin and standard of care in cancer-associated VTE (CA-VTE). Tinzaparin has the highest molecular weight of all LMWH and relies least on renal clearance to Cockcroft-Gault creatinine clearance (CrCl) of 20 mL/min. Previous pharmacological studies have demonstrated safety and effectiveness in elderly patients. Prospective clinical trials have confirmed these findings to CrCl 20 mL/min and in CA-VTE. We describe the pilot program developed at Concord Repatriation General Hospital for tinzaparin.

AIMS:

We aim to confirm the deliverability of tinzaparin in patients with renal insufficiency.

METHODS:

Twenty patients were established on tinzaparin as therapeutic anticoagulation with CrCl or CKD-EPI estimated glomerular filtration rate (eGFR) 20-50 mL/min with an indication for anticoagulation. Tinzaparin was given as a subcutaneous injection at 175 units/kg as a single daily dose, rounded to the nearest vial size. Tinzaparin anti-Xa levels were tested at Days 2, 7 and 14 (±1 day) and transition to oral anticoagulants were allowed at clinician discretion.

RESULTS:

No accumulation of tinzaparin was seen into Day 14. Two patients required dose-adjustment, five patients had bleeding complications (two major, three minor) and four patients died during follow-up, all attributable to patients' comorbidities. CrCl and body surface area-standardised CrCl were significantly correlated with tinzaparin anti-Xa level only on Day 2, and this effect was lost when patients with CrCl >50 mL/min were excluded. Data from our cohort confirm the deliverability of therapeutic tinzaparin in patients with CrCl or CKD-EPI eGFR 20-50 mL/min. Bleeding and death outcomes were also comparable to other trials using tinzaparin in CA-VTE.

CONCLUSION:

For patients with renal insufficiency, tinzaparin represents an attractive alternative anticoagulant with once-daily administration in a range of potential indications.

• Authors: James Yeung, Caroline H K Dix, Angus G Ritchie, Marian Kow, Vivien M Y Chen
• Journal: Internal medicine journal (Intern Med J) Vol. 53 Issue 1 Pg. 68-73 (01 2023) ISSN: 1445-5994 [Electronic] Australia
• PMID: 32786035 (Publication Type: Journal Article)
• Copyright: © 2020 Royal Australasian College of Physicians.

Chemical References

• Tinzaparin
• Heparin, Low-Molecular-Weight
• Anticoagulants

Topics

• Humans
• Aged
• Tinzaparin (therapeutic use)
• Heparin, Low-Molecular-Weight (therapeutic use)
• Pilot Projects
• Venous Thromboembolism (prevention & control)
• Prospective Studies
• Anticoagulants (adverse effects)
• Renal Insufficiency (chemically induced)
• Renal Insufficiency, Chronic (drug therapy)