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.