Abstract
Low-molecular-weight heparins are approved for primary and secondary venous
thromboembolism prevention. Tinzaparin is the low-molecular-weight heparin with
the highest average molecular weight. The purpose of this systematic review is
to provide an update regarding the safety profile of tinzaparin, prescribed
either as a prophylactic or as a therapeutic regimen for venous thromboembolism
in special populations, including cancer patients and patients with renal
impairment. We identified prospective studies up to August 2020 reporting safety
outcomes for cancer patients and patients with renal impairment on tinzaparin
regimens. In patients with cancer major bleeding rates fluctuated between 0.8%
and 7%. Patients on tinzaparin exhibited significantly lower rates of clinically
relevant nonmajor bleeding events in comparison with those on vitamin K
antagonists. Bioaccumulation of tinzaparin was not correlated with age, body
weight or creatinine clearance. Periodic administration of either prophylactic
or therapeutic doses of tinzaparin did not result in bioaccumulation, even in
patients with severe renal impairment and creatinine clearance < 20 ml/min.
Major bleeding rates for non-cancer patients with renal impairment on
prophylactic tinzaparin regimens were 0%. Non-cancer patients with renal
impairment on therapeutic tinzaparin regimens exhibited major bleeding in 0 to
3.4% of cases; major bleeding rates were higher for cancer patients with renal
impairment on therapeutic tinzaparin regimens (4.3 to 10%). Tinzaparin can be
used without dose adjustment in patients with severe renal impairment and
creatinine clearance > 20 ml/min. Tinzaparin represents a safe choice for
special populations at increased risk for thrombosis and bleeding.
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