Intravenous and subcutaneous weight-based dosing of the low molecular weight heparin tinzaparin (Innohep) in end-stage renal disease patients undergoing chronic hemodialysis

Hainer, James W.; Sherrard, Donald J.; Swan, Suzanne K.; Barrett, Jeffrey S.; Assaid, Christopher; Fossler, Michael J.; Cox, Donna S.; Williams, Robert M.; Pittenger, Amy L.; Stephenson, Carol; Hua, Tsushung A.

doi:10.1053/ajkd.2002.34911

Cited by 28 publications

(19 citation statements)

References 15 publications

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“…The patients did not show any obvious changes in bleeding or clotting tendency, comparing the two heparin preparations. Our observations on the efficacy and safety of tinzaparin as anticoagulant in HD are in line with earlier studies [1,7-9,11-13,15]. Notable is, that in one of these studies the extent of clotting was increased in the venous bubble traps with tinzaparin [13], indicating an increased tendency of clotting.…”

Section: Discussionsupporting

confidence: 91%

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Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

et al. 2010

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BackgroundLow molecular weight (LMW) heparins are used for anticoagulation during hemodialysis (HD). Studies in animals have shown that LMW-heparins release lipoprotein lipase (LPL) as efficiently as unfractionated (UF) heparin, but are less able to retard hepatic uptake of the lipase. This raises a concern that the LPL system may become exhausted by LMW-heparin in patients on HD. We have explored this in the setting of clinical HD.MethodsTwenty patients on chronic hemodialysis were switched from a primed infusion of UF-heparin to a single bolus of tinzaparin. There were long term follow up of variables for the estimation of dialysis efficacy as well as of the LPL release during dialysis and the subsequent impact on the triglycerides.ResultsThe LPL activity in blood was higher on tinzaparin at 40 but lower at 180 minutes during HD. These values did not change during the 6 month study period. There were significant correlations between the LPL activities in individual patients at the beginning and end of the 6 month study period and between the activities on UF-heparin and on tinzaparin, indicating that tissue LPL was not being exhausted. Triglycerides were higher during the HD-session with tinzaparin than UF-heparin. The plasma lipid/lipoprotein levels did not change during the 6 month study period, nor during a 2-year follow up after the switch from UF-heparin to tinzaparin. Urea reduction rate and Kt/V were reduced by 4 and 7% after 6 months with tinzaparin.ConclusionOur data demonstrate that repeated HD with UF-heparin or tinzaparin does not exhaust the LPL-system.

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Section: Discussionsupporting

confidence: 91%

“…This is in line with the dose of 75 anti-Xa units/kg body weight used in a detailed study of the pharmacokinetics of tinzaparin in patients undergoing HD [11-13]. …”

Section: Resultssupporting

confidence: 64%

Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

et al. 2010

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“…Studies have shown decreased clearance of enoxaparin in patients with renal failure compared with patients without renal failure (5). Other studies that have used tinzaparin have not observed bioaccumulation even at low levels of calculated creatinine clearance (48). Thus, combining LMWH may result in an overall estimate that, although useful, does not reflect the true risk of an individual LMWH.…”

Section: Discussionmentioning

confidence: 97%

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

Lim¹,

Cook²,

Crowther³

2004

Journal of the American Society of Nephrology

154

128

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Abstract. Low molecular weight heparins (LWMH) are the preferred initial treatment for many thromboembolic disorders but are renally excreted and relatively contraindicated in patients with renal failure because of concerns of increased bleeding risks. The purpose of this study was to evaluate the safety and efficacy of LMWH compared with unfractionated heparin (UFH) for preventing thrombosis of the extracorporeal dialysis circuit. Studies were identified with the use of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and FirstSearch; reference lists were reviewed; and pharmaceutical companies were contacted. Randomized, controlled trials that compared an LMWH with another anticoagulant during hemodialysis in patients with ESRD and reported at least one of bleeding, extracorporeal circuit thrombosis, or anti-Xa levels were chosen. Two reviewers independently extracted data on methodologic quality, study design, clinical outcomes, and anti-Xa levels. Seventeen trials were included in this systematic review, 11 of which were included in the meta-analysis. It was found that LMWH did not significantly affect the number of bleeding events (relative risk, 0.96; 95% confidence interval [CI], 0.27 to 3.43), bleeding assessed by vascular access compression time (weighted mean difference, Ϫ0.87; 95% CI, Ϫ2.75 to 1.02), or extracorporeal circuit thrombosis (relative risk, 1.15; 95% CI, 0.70 to 1.91) as compared with UFH.

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“…Various dosing regimes of Tinzaparin have been described, including fixed (1,250–5,000 U) starting dose adjusted according to clinical response [35], weight-based dosing regimes [36] and bolus injections followed by continuous infusions of UFH [35] or LMWH [22]. Previous UFH dose does not appear to be related to the amount of LMWH required [23].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Tinzaparin™ and Unfractionated Heparin as Anticoagulation on Haemodialysis: Equal Safety, Efficacy and Economical Parity

et al. 2008

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Background: The European Best Practice Guidelines on anticoagulation in chronic haemodialysis recommend the use of low-molecular-weight heparins (LMWH) over unfractionated heparin (UFH), based on previous small-scale studies and a meta-analysis which demonstrated equal efficacy of anticoagulation without an increase in hemorrhagic events. Method: We performed a prospective single-centre study where all stable patients on chronic in-hospital haemodialysis were converted from UFH to Tinzaparin™. Patients were monitored for 2 months before and 2 months after the switch. Access failures due to thrombosis, clotted circuits and hemorrhagic events were recorded. Results: 1,489 and 1,823 dialysis sessions took place on UFH and LMWH, respectively, in 108 patients (65 male). The total number of clotted circuits tended to decrease after the switch to LMWH (34 vs. 13) but was not statistically significant. There were four minor non-access-related episodes of haemorrhage while on treatment with UFH and none with Tinzaparin, and the length of bleeding time post needle removal was shorter with Tinzaparin than UFH. The cost-analysis demonstrated parity of Tinzaparin with UFH; using a median of 10,000 U of UFH versus 2,500 U of LMWH, each therapy cost GBP 10,783 (EUR 15,942; USD 20,446) per annum. Conclusion: Our findings suggest comparable safety and efficacy of Tinzaparin, parity of cost in comparison with UFH.

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Intravenous and subcutaneous weight-based dosing of the low molecular weight heparin tinzaparin (Innohep) in end-stage renal disease patients undergoing chronic hemodialysis

Cited by 28 publications

References 15 publications

Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis

Safety and Efficacy of Low Molecular Weight Heparins for Hemodialysis in Patients with End-Stage Renal Failure

Comparison of Tinzaparin™ and Unfractionated Heparin as Anticoagulation on Haemodialysis: Equal Safety, Efficacy and Economical Parity

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