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Low Molecular Weight Heparin — VTE Treatment / Prophylaxis Pregnancy: Safe in pregnancy — does not cross placenta; preferred over DOACs

Tinzaparin

Brand names: Innohep

Adult dose

Dose: VTE treatment: 175 units/kg SC once daily; VTE prophylaxis (surgical): 3500 units SC once daily; High-risk prophylaxis: 4500 units or 50 units/kg once daily
Route: Subcutaneous injection
Frequency: Once daily
Max: Weight-based — no absolute maximum stated; use anti-Xa monitoring if concerned
Inject into abdominal SC fat. Start prophylaxis 2 hours before surgery (general) or 12 hours before (neuraxial anaesthesia). Antidote: protamine sulphate (partially reverses).

Paediatric dose

Dose: 175 units/kg units/kg
Route: Subcutaneous
Frequency: Once daily
Max: Seek paediatric haematology guidance
BNFc: weight-based; limited data in children — specialist guidance required

Dose adjustments

Renal

MHRA: tinzaparin may be used in severe renal impairment (CrCl <30) with anti-Xa monitoring — notably less accumulation than other LMWHs in this context (Innohep UK licence)

Hepatic

Use with caution

Paediatric weight-based calculator

BNFc: weight-based; limited data in children — specialist guidance required

Clinical pearls

  • Tinzaparin is the only LMWH with UK MHRA licence for use in patients with severe renal impairment (CrCl <20–30) based on anti-Xa pharmacokinetics showing less accumulation — important clinical advantage in oncology and elderly patients
  • Once-daily dosing and weight-based convenience comparable to dalteparin
  • 175 units/kg once daily for treatment — easy calculation, single daily injection

Contraindications

  • Active major bleeding
  • History of HIT
  • Severe thrombocytopaenia

Side effects

  • Bleeding
  • Injection site bruising/haematoma
  • HIT (rare)
  • Hyperkalaemia
  • Osteoporosis (prolonged use)
  • Elevated LFTs

Interactions

  • Anticoagulants — additive
  • NSAIDs/antiplatelets — additive bleeding

Monitoring

  • Anti-Xa levels (severe renal impairment, obesity, pregnancy)
  • FBC (HIT monitoring)
  • Renal function and potassium
  • Signs of bleeding

Reference: BNFc; BNF 90; MHRA SPC Innohep; IRIS Study (Renal Impairment); NICE NG89. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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