Medicines

Tinzaparin a novel LMWH option for patients with impaired renal function


Tinzaparin is an attractive option for a low molecular weight heparin (LMWH) that can be considered for elderly patients with chronic kidney disease where there are concerns for drug accumulation, an Australian pilot study suggests.

The drug can be used without dose adjustment as it has less renal clearance than other LMWH and is therefore suitable for VTE prevention in patients with a with creatinine clearance (CrCl) down to 20ml/min, according to clinicians who trialled the drug at a Sydney hospital.

In a pilot program developed at Concord Repatriation General Hospital, 20 patients were established on tinzaparin as therapeutic anticoagulation with CrCl or estimated glomerular filtration rate (eGFR) of 20-50ml/min with an indication for anticoagulation.

Eight patients received tinzaparin as bridging therapy for a few days and twelve were placed on extended duration LMWH therapy for up to 15 months (median 6.3 months). The median age was 78 years and five patients were receiving anticoagulation for cancer-related VTE.

The study found no accumulation of tinzaparin up to day 14 of follow up, and no correlation between creatinine clearance and anti-FXa levels at day 7 or 14.

While there was a positive correlation between weight and anti-FXa levels at day 2 and 7, the association was not present at day 14.

Thus, the study supported guidelines recommendations for simple weight-based dosing with tinzaparin without adjustment for renal function, the study investigators said.

Over the extended follow period of up to 15 months, no incidences of recurrent VTE were reported. 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.

Study lead author Dr James Yeung, a haematologist at the hospitals told the limbic that tinzaparin appeared to be an attractive alternative anticoagulant with once-daily administration in a range of potential indications including cancer VTE, bridging therapy.

“This has important clinical implications [as] we have an ageing population, with an increasing burden of disease both with chronic kidney disease and cancer,” he said.

“Inpatient hospital bed shortages will become an issue, if not already. Tinzaparin represents an option for those in whom once-daily dosing would be suitable for inpatients and outpatients.

Dr Yeung noted that tinzaparin is not listed on the PBS or funded in most hospitals in Australia, but on the basis of the study has been approved by the Concord Hospital formulary.

At a cost of approximately $20 tinzaparin was more expensive than enoxaparin (approx. $6) and heparin infusion ($15) but could be cost effective as its once daily dosing allowed it to be delivered via Hospital in the Home

“We recognise that tinzaparin use represents a niche within the broader anticoagulation armament. In patients whom LMWH is indicated, but prefer daily dosing with CKD and concerns for drug accumulation, tinzaparin represents an effective option,” he concluded.

The findings are published in the Internal Medicine Journal. The authors state they have no financial, industry or other or conflicts of interest to declare.

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