Tinzaparin Pilot Program At Concord Repatriation General Hospital
James Yeung, Royal Prince Alfred, Australia
Aims: Low molecular weight heparins (LMWH) are ubiquitous in Australian hospitals through its use in 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 estimated glomerular filtration rate (eGFR) of 20ml/min. Previous pharmacological studies and prospective clinical trials have confirmed safety and effectiveness of tinzaparin to eGFR 20ml/min and in CA-VTE.
Methods: We describe the tinzaparin pilot program developed at Concord Repatriation General Hospital. A total of eighteen patients were established on tinzaparin as therapeutic anticoagulation either in acute or chronic kidney disease with eGFR 20 to 50ml/min and/or cancer-associated VTE. Sixteen patients had eGFR 20 to 50ml/min, while two patients had CA-VTE as the sole indication. Five patients had both eGFR and CA-VTE indications. Tinzaparin anti-Xa levels were measured at days 2, 7 and 14 (+/- one day) in keeping with previous studies. Transition to oral anticoagulants was allowed at the discretion of the treating physician.
Results: All but two patients measured within therapeutic anti-Xa levels with no accumulation into day 14. One patient was sub-therapeutic requiring up-titration, and one patient experienced epistaxis requiring dose-reduction. Five patients transitioned to oral anticoagulants and bleeding complications were mild. Three patients died during follow-up which was attributed to causes outside of tinzaparin use.
Conclusions: We confirm previous findings of safety and effectiveness using therapeutic tinzaparin in patients with eGFR 20 to 50ml/min, leading to its approval for the pharmacy formulary at Concord Hospital. Despite a niche indication, tinzaparin is an attractive alternative with a once-daily dosing regimen, and holds potential in reducing inpatient stays whilst maintaining the safety profile of LMWH.
References:
1. Mahé et al., Thromb Haemost. 2007 April; 97(4):581-5862. Lee et al., JAMA. 2015 August 18; 314(7):677-686
Aims: Low molecular weight heparins (LMWH) are ubiquitous in Australian hospitals through its use in 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 estimated glomerular filtration rate (eGFR) of 20ml/min. Previous pharmacological studies and prospective clinical trials have confirmed safety and effectiveness of tinzaparin to eGFR 20ml/min and in CA-VTE.
Methods: We describe the tinzaparin pilot program developed at Concord Repatriation General Hospital. A total of eighteen patients were established on tinzaparin as therapeutic anticoagulation either in acute or chronic kidney disease with eGFR 20 to 50ml/min and/or cancer-associated VTE. Sixteen patients had eGFR 20 to 50ml/min, while two patients had CA-VTE as the sole indication. Five patients had both eGFR and CA-VTE indications. Tinzaparin anti-Xa levels were measured at days 2, 7 and 14 (+/- one day) in keeping with previous studies. Transition to oral anticoagulants was allowed at the discretion of the treating physician.
Results: All but two patients measured within therapeutic anti-Xa levels with no accumulation into day 14. One patient was sub-therapeutic requiring up-titration, and one patient experienced epistaxis requiring dose-reduction. Five patients transitioned to oral anticoagulants and bleeding complications were mild. Three patients died during follow-up which was attributed to causes outside of tinzaparin use.
Conclusions: We confirm previous findings of safety and effectiveness using therapeutic tinzaparin in patients with eGFR 20 to 50ml/min, leading to its approval for the pharmacy formulary at Concord Hospital. Despite a niche indication, tinzaparin is an attractive alternative with a once-daily dosing regimen, and holds potential in reducing inpatient stays whilst maintaining the safety profile of LMWH.
References:
1. Mahé et al., Thromb Haemost. 2007 April; 97(4):581-5862. Lee et al., JAMA. 2015 August 18; 314(7):677-686
