What is Tinzaparin
Tinzaparin is a low-molecular-weight heparin (LMWH) produced by controlled enzymatic depolymerization of heparin from porcine mucosa using a heparinase from Flavobacterium heparinum.
Tinzaparin molecules range from 2000—8000 daltons, with an average molecular weight of 5500—7500 daltons.
Less than 10% of the molecules are less than 2000 daltons, 60—72% of the molecules are 2000—8000 daltons, and 22—36% of the molecules are greater than 8000 daltons.
The mean anti-factor Xa activity of tinzaparin is 100 IU/mg.
Tinzaparin and other LMWHs produce a more predictable anticoagulant response than unfractionated heparin, reflecting their better bioavailability after subcutaneous injection, longer half-life, and dose-independent clearance.
In a double blind clinical trial of patients with symptomatic proximal deep vein thrombosis (DVT), tinzaparin has been shown to be equivalent to standard heparin therapy in the prevention of recurrent DVT and/or pulmonary embolism (PE).
Mortality for tinzaparin in this study was 4.6% (10 patients) as compared to 9.6% (21 patients) with heparin; this difference was not statistically significant.
The FDA approved tinzaparin (Innohep®) for the treatment of acute symptomatic DVT with or without PE in July 2000.
Brand Name
Innohep
Indications
- antiphospholipid antibody syndrome
- cerebral thromboembolism
- deep venous thrombosis (DVT)
- pulmonary embolism
Side Effects
- abdominal pain
- agranulocytosis
- anaphylactoid reactions
- anemia
- angina
- angioedema
- arrhythmia exacerbation
- back pain
- bleeding
- bullous rash
- chest pain (unspecified)
- coma
- confusion
- constipation
- cystitis
- diarrhea
- disseminated intravascular coagulation (DIC)
- dizziness
- dyspepsia
- dysphagia
- dyspnea
- dysuria
- ecchymosis
- edema
- elevated hepatic enzymes
- epistaxis
- fetal death
- fetal distress
- fever
- flatulence
- GI bleeding
- headache
- hematemesis
- hematoma
- hematuria
- hemoptysis
- hepatitis
- hypertension
- hypotension
- hypotonia
- impaired wound healing
- infection
- injection site reaction
- insomnia
- intracranial bleeding
- maculopapular rash
- melena
- muscle paralysis
- musculoskeletal pain
- myocardial infarction
- nausea
- new primary malignancy
- ocular hemorrhage
- osteoporosis
- pancytopenia
- paresthesias
- priapism
- pruritus
- pulmonary embolism
- purpura
- rash
- retroperitoneal bleeding
- sinus tachycardia
- skin irritation
- skin necrosis
- spinal hematoma
- spontaneous fetal abortion
- Stevens-Johnson syndrome
- teratogenesis
- thrombocytopenia
- thromboembolism
- urinary retention
- urticaria
- vaginal bleeding
- vomiting
- weakness
Monitoring Parameters
- anti-Xa activity
- hemoglobin/hematocrit
- platelet count
- serum creatinine
- stool guaiac
- urinalysis
Contraindications
- aneurysm
- anticoagulant therapy
- asthma
- benzyl alcohol hypersensitivity
- bleeding
- breast-feeding
- children
- coagulopathy
- dental disease
- dental work
- diabetic retinopathy
- diverticulitis
- endocarditis
- epidural anesthesia
- geriatric
- GI bleeding
- heparin hypersensitivity
- heparin-induced thrombocytopenia (HIT)
- hepatic disease
- hypertension
- inflammatory bowel disease
- intramuscular injections
- lumbar puncture
- menstruation
- neonates
- obesity
- peptic ulcer disease
- porcine protein hypersensitivity
- pregnancy
- prosthetic heart valves
- renal disease
- renal failure
- renal impairment
- spinal anesthesia
- stroke
- sulfite hypersensitivity
- surgery
- thrombocytopenia
- thrombolytic therapy
Interactions
- Abciximab
- Ado-Trastuzumab emtansine
- Alteplase
- Altretamine
- Amlodipine; Celecoxib
- Anagrelide
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Argatroban
- Arsenic Trioxide
- Aspirin, ASA; Dipyridamole
- Bivalirudin
- Caplacizumab
- Carbenicillin
- Celecoxib
- Chlorambucil
- Cilostazol
- Clofarabine
- Collagenase
- Cytarabine, ARA-C
- Dabigatran
- Dalteparin
- Danaparoid
- Danazol
- Dasatinib
- Decitabine
- Deferasirox
- Defibrotide
- Denileukin Diftitox
- Desirudin
- Dextran
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Dipyridamole
- Drotrecogin Alfa
- Edoxaban
- Eltrombopag
- Enoxaparin
- Epoprostenol
- Eptifibatide
- Esomeprazole; Naproxen
- Esterified Estrogens; Methyltestosterone
- Estramustine
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Floxuridine
- Fluorouracil, 5-FU
- Flurbiprofen
- Folate analogs
- Fondaparinux
- Garlic, Allium sativum
- Ginger, Zingiber officinale
- Ginkgo, Ginkgo biloba
- Green Tea
- Hemin
- Heparin
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrocodone; Ibuprofen
- Hydroxyurea
- Ibritumomab Tiuxetan
- Ibrutinib
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Icosapent ethyl
- Iloprost
- Imatinib
- Indomethacin
- Inotersen
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Intravenous Lipid Emulsions
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lepirudin
- Lomustine, CCNU
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methoxsalen
- Methylsulfonylmethane, MSM
- Methyltestosterone
- Mifepristone
- Miltefosine
- Mycophenolate
- Nabumetone
- Nandrolone Decanoate
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Natural Antineoplastics
- Nelarabine
- Nintedanib
- Nonsteroidal antiinflammatory drugs
- Obinutuzumab
- Omacetaxine
- Orlistat
- Oxandrolone
- Oxaprozin
- Palifermin
- Pentosan
- Phentermine; Topiramate
- Piperacillin
- Piperacillin; Tazobactam
- Piroxicam
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prasugrel
- Reteplase, r-PA
- Rivaroxaban
- Rofecoxib
- Salicylates
- Selective serotonin reuptake inhibitors
- Serotonin norepinephrine reuptake inhibitors
- Sodium Hyaluronate, Hyaluronic Acid
- Sodium Iodide
- Sorafenib
- Spironolactone
- Streptokinase
- Sulfinpyrazone
- Sulindac
- Telavancin
- Tenecteplase
- Thrombolytic Agents
- Ticagrelor
- Ticarcillin
- Ticarcillin; Clavulanic Acid
- Ticlopidine
- Tipranavir
- Tirofiban
- Tolmetin
- Topiramate
- Trazodone
- Treprostinil
- Tretinoin, ATRA
- Urokinase
- Valdecoxib
- Verteporfin
- Vilazodone
- Vorapaxar
- Vorinostat
- Vortioxetine
- Warfarin
