Tinzaparin Sodium

A to Z Drug Facts

 Action Inhibits reactions that lead to the clotting of blood, including the formation of fibrin clots.

 Indications Treatment of acute symptomatic deep vein thrombosis with or without pulmonary embolism when administered with warfarin.

 Contraindications Active major bleeding, heparin-induced thrombocytopenia, hypersensitivity to heparin, sulfites, benzyl alcohol, or pork products.

 Route/Dosage

ADULTS: SC 175 anti-Xa IU/kg once daily for > 6 days and until patient is adequately anticoagulated with warfarin.

 Interactions

Anticoagulants, platelet inhibitors (eg, dipyridamole, NSAIDs, salicylates): Use with caution because of increased risk of bleeding.

 Lab Test Interferences Asymptomatic reversible increases in AST and ALT concentrations.

 Adverse Reactions

CV: Cardiac arrhythmia, hypertension; hypotension; pulmonary embolism; tachycardia; thrombophlebitis. CNS: Confusion; dizziness; headache; insomnia. DERM: Bullous eruption; epidermal necrolysis; rash; skin disorder; skin necrosis. EENT: Epistaxis; hearing impairment; ocular hemorrhage. GI: Abdominal pain; constipation; dyspepsia; flatulence; nausea; vomiting. GU: Dysuria; hematuria; priapism; urinary retention; urinary tract infection. HEMA: Anemia; bleeding; ecchymosis; hematoma; hemorrhage; thrombocytopenia. HEPA: Elevated ALT and AST. OTHER: Anaphylactoid reactions; back pain; chest pain; fever; hypersensitivity; local irritation; pain; pruritus; rectal bleeding. RESP: Dyspnea; pneumonia; respiratory disorder.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Epidural/Spinal anesthesia: When neuraxial anesthesia or spinal puncture is employed, patients who are anticoagulated or scheduled to be anticoagulated with low molecular weight heparins are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. Renal impairment: Effect of tinzaparin may be prolonged. Hemorrhage: Use with caution in conditions with increased risk of hemorrhage (eg, bacterial endocarditis, severe uncontrolled hypertension, active ulcerative GI disease). Hypersensitivity: Allergic-type reactions may occur caused by sodium metabisulfite present in tinzaparin. Fatal gasping syndrome: Fatal gasping syndrome in premature infants has been associated with benzyl alcohol preservative present in tinzaparin.

 Administration/Storage

• Store at room temperature (77°F, 25°C) range allowed (59° to 86°F, 15° to 30°C).
• Inspect the clear, colorless to slightly yellow solution, and do not administer if particulate matter or discoloration is present.
• Assess all patients for bleeding disorders before administration of tinzaparin.
• Administer weight-adjusted dose by deep SC injection only.
• Place the patient in the supine or sitting position before administration.
• Alternate injection sites between the left and right anterolateral and left and right posterolateral abdominal wall.
• Hold skinfold between the thumb and forefinger until the injection is completed.
• Introduce the full length of the needle into the skinfold and inject without aspiration.
• To minimize bruising, do not massage the injection site.
• DO NOT administer IM or IV or mix with other injections or infusions.
• Do not administer to patients with active major bleeding, a history of heparin-induced thrombocytopenia, or a hypersensitivity to heparin, sulfites, benzyl alcohol, or pork products.
• Administer with extreme caution and under close medical supervision to patients with increased risk of hemorrhage, uncontrolled arterial hypertension, history of GI ulceration, and diabetic retinopathy.
• Administer with caution to patients with impaired liver function, renal failure, and those at risk for decreased renal function such as the elderly.
• Administer to pregnant women with caution and only if clearly needed as benzyl alcohol may cross the placenta causing fatalities in premature infants.
• Administer with caution to nursing mothers as tinzaparin is found in low concentrations in breast milk.
• Do not interchange unit for unit with heparin or any other low-molecular weight anticoagulant.

 Assessment/Interventions

• Obtain a complete drug history and assess for allergies and potential drug interactions (ie, oral anticoagulants, platelet inhibitors, salicylates, dipyridamole, sulfinpyrazone, dextran and NSAIDs, thrombolytics).
• If coadministration with these medications is necessary, close laboratory and clinical monitoring is needed.
• Assess periodic hematocrit, hemoglobin, and platelet counts.
• Neither aPTT or PT can be used for therapeutic monitoring of tinzaparin sodium.
• Assess patient for signs and symptoms that might indicate bleeding or other adverse occurrences. These could include hypertension or hypotension, dizziness, irritability, insomnia, confusion, dyspepsia or other symptoms of ulcers, occult blood in stool, tachycardia, angina, thrombocytopenia, priapism, anemia, impaired healing, infection, dysuria, calf tenderness or pain, purpura, hematoma, or other skin indications of problems.
• Closely monitor patients following spinal or epidural anesthesia as they are at risk for developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.
• The risk is increased if an indwelling epidural catheter is used; repeated or traumatic epidural or spinal procedures are employed; or concomitant use of anticoagulant drugs including NSAIDs and platelet inhibitors are utilized.
• Most bleeding complications can be controlled by discontinuing tinzaparin and applying pressure to the site.
• Tinzaparin has a half-life of » 3 to 4 hr.
• If needed, blood elements and volume can be replaced.
• In case of serious bleeding or large overdose, protamine sulfate can be given by slow IV infusion.
• Only give protamine sulfate when resuscitation facilities are readily available, as fatal reactions have occurred.

 Patient/Family Education

• Instruct patient to take safety precautions to avoid cuts and bruises (eg, soft toothbrush, electric razor, handrails).
• Caution patient to avoid aspirin or other EMPH: otc anticoagulants.
• Instruct patients to report any current or future prescription, EMPH: otc, or herbal medication use to primary care provider.
• Advise patient to report bruises, bleeding, nosebleeds, bleeding gums, coffee-ground emesis, red-flecked sputum, or tarry, black, or red stools.
• Explain the rationale for follow-up examinations and laboratory studies to ensure effectiveness of medication and prevention of complications or side effects.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts