Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications

Abstract

Low-molecular-weight heparins (LMWHs) are the mainstay of the prophylaxis and treatment of venous thromboembolism (VTE). Due to their renal elimination, the risk of accumulation with the related bleeding risk may represent a limitation for the use of LMWHs in patients with chronic kidney disease (CKD) as the risk of major bleeding is increased in patients with creatinine clearance (CrCl) < 30 mL/min, especially in patients with cancer. LMWH structure and molecular weight (MW) are heterogeneous among available agents. The elimination of tinzaparin, which has the highest mean MW among LMWHs, is less dependent on renal function as it is also metabolized through the reticuloendothelial system. A subcutaneous therapeutic dose of tinzaparin (175 IU/kg) once daily has been shown to cause no accumulation of anti-factor Xa activity in patients with CrCl ≥ 20 mL/min. Clinical experience from randomized controlled studies has shown no significant impact of CKD on bleeding risk in cancer patients receiving treatment doses of tinzaparin. This suggests that in these patients the use of treatment doses of tinzaparin does not require anticoagulation monitoring or dose adjustment.

Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

“…27,28 Thromboprophylaxis is required in all ICU patients, choosing mainly LMWH with longer polysaccharide chains less eliminated by kidney route such as tinzaparin or dalteparin, which can be used even in cases of creatinine clearance between 20 and 30 mL/min. [28][29][30] Nevertheless, VTE can occur despite well-conducted thromboprophylaxis. 31 Prevention Strategies for Severe and Critically Ill Patients at High Risk of Bleeding Most severe and critically ill COVID-19 patients may have underlying diseases, coagulation disorders, hormone treatment history, or other circumstances such as severe liver dysfunction, resulting the increase of bleeding risk, so factors that may lead to bleeding should be corrected actively.…”

Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study

“…Chronic venous disease (CVD) is one of the most common peripheral vascular diseases, with varicose veins of lower extremities as the main manifestation [ 1 ]. The incidence rate is about 25-40% in the adult population worldwide [ 2 ]. Its clinical manifestations such as swelling, pigmentation, lipid sclerosis, and ulceration seriously affect patients' physical and mental health and greatly increase the social and economic burden [ 3 , 4 ].…”

Case report of a ‘snake thrombus’ in the right heart: a rare finding on echocardiography

“…However, several studies have meanwhile addressed this issue. 17 , 18 Tinzaparin has the highest molecular weight among LMWH (see Table 3 ) and is therefore less dependent on renal clearance as it is mainly metabolized through the reticulo-endothelial system. Tinzaparin stands out as no dose reduction (of the therapeutic dose of 175 IU/kg) or factor Xa measurement is needed if the GFR is above 20 mL/min (as opposed to >30 mL/min for e.g.…”