Tinzaparin

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

  1. antiphospholipid antibody syndrome
  2. cerebral thromboembolism
  3. deep venous thrombosis (DVT)
  4. pulmonary embolism

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. anemia
  5. angina
  6. angioedema
  7. arrhythmia exacerbation
  8. back pain
  9. bleeding
  10. bullous rash
  11. chest pain (unspecified)
  12. coma
  13. confusion
  14. constipation
  15. cystitis
  16. diarrhea
  17. disseminated intravascular coagulation (DIC)
  18. dizziness
  19. dyspepsia
  20. dysphagia
  21. dyspnea
  22. dysuria
  23. ecchymosis
  24. edema
  25. elevated hepatic enzymes
  26. epistaxis
  27. fetal death
  28. fetal distress
  29. fever
  30. flatulence
  31. GI bleeding
  32. headache
  33. hematemesis
  34. hematoma
  35. hematuria
  36. hemoptysis
  37. hepatitis
  38. hypertension
  39. hypotension
  40. hypotonia
  41. impaired wound healing
  42. infection
  43. injection site reaction
  44. insomnia
  45. intracranial bleeding
  46. maculopapular rash
  47. melena
  48. muscle paralysis
  49. musculoskeletal pain
  50. myocardial infarction
  51. nausea
  52. new primary malignancy
  53. ocular hemorrhage
  54. osteoporosis
  55. pancytopenia
  56. paresthesias
  57. priapism
  58. pruritus
  59. pulmonary embolism
  60. purpura
  61. rash
  62. retroperitoneal bleeding
  63. sinus tachycardia
  64. skin irritation
  65. skin necrosis
  66. spinal hematoma
  67. spontaneous fetal abortion
  68. Stevens-Johnson syndrome
  69. teratogenesis
  70. thrombocytopenia
  71. thromboembolism
  72. urinary retention
  73. urticaria
  74. vaginal bleeding
  75. vomiting
  76. 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
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