Tinzaparin sodium

How it works

It potentiates antithrombin, principally inhibiting activated factor Xa (with some antithrombin activity), thereby reducing thrombin generation and clot formation.

Prescribing in practice

• Bleeding is the main risk; assess bleeding risk before and during treatment.
• It accumulates in renal impairment (use with caution and consider anti-Xa monitoring), and platelets should be monitored for heparin-induced thrombocytopenia.
• Around neuraxial (spinal or epidural) anaesthesia there is a risk of spinal/epidural haematoma, so observe the recommended timing intervals.

Monitoring

Monitor for bleeding, check platelet counts for heparin-induced thrombocytopenia, and consider anti-Xa activity in renal impairment, extremes of body weight or pregnancy; note it is only partially reversed by protamine.

Counselling the patient

• Tell your healthcare team straight away about any unusual bruising or bleeding, such as nosebleeds, blood in your urine or stools, or black stools.
• If you give the injections yourself, you will be shown how to do this and how to rotate the injection sites.
• Mention this medicine before any planned spinal or epidural procedure or surgery.

Evidence & guidelines

An established low-molecular-weight heparin in NICE guidance on venous thromboembolism prophylaxis and management.