Home Drug Guide Tinzaparin Sodium

Drug Guide

Generic Name

Tinzaparin Sodium

Brand Names Innohep

Classification

Therapeutic: Anticoagulant, Low Molecular Weight Heparin (LMWH)

Pharmacological: Antithrombotic, Anticoagulant

FDA Approved Indications

Deep vein thrombosis (DVT) treatment and prophylaxis
Management of acute coronary syndromes

Mechanism of Action

Tinzaparin enhances the activity of antithrombin III, leading to inhibition of factor Xa and IIa (thrombin), thereby preventing clot formation.

Dosage and Administration

Adult: Typically 4,500 IU subcutaneously once daily; dosage may vary based on indication and patient factors.

Pediatric: Not approved for use in children.

Geriatric: Adjust dosing based on renal function; no specific age adjustment but monitor renal function carefully.

Renal Impairment: Use with caution; dose adjustment may be necessary based on renal function.

Hepatic Impairment: No specific adjustments recommended, but caution advised.

Pharmacokinetics

Absorption: Well absorbed after subcutaneous injection.

Distribution: Limited volume of distribution; does not cross the placenta appreciably.

Metabolism: Metabolized by the reticuloendothelial system.

Excretion: Renally excreted, accumulation possible in renal impairment.

Half Life: Approximately 4.5 hours.

Contraindications

Hypersensitivity to tinzaparin or heparins
History of heparin-induced thrombocytopenia (HIT)
Active major bleeding

Precautions

Use with caution in renal impairment, bleeding disorders, recent surgery, or lumbar puncture

Adverse Reactions - Common

Bleeding (Common)
Hematoma at injection site (Common)
Thrombocytopenia (Uncommon)

Adverse Reactions - Serious

Heparin-induced thrombocytopenia (HIT) (Rare)
Severe bleeding (Rare)

Drug-Drug Interactions

Other anticoagulants, antiplatelet agents, NSAIDs

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, check platelet counts, renal function before and during therapy.

Diagnoses:

Risk for bleeding
Ineffective tissue perfusion related to bleeding

Implementation: Administer subcutaneously, rotate injection sites, monitor labs.

Evaluation: Assess for bleeding complications, monitor platelet counts.

Patient/Family Teaching

Report signs of bleeding immediately (e.g., unusual bruising, blood in stool/urine, headache).
Do not aspirate or massage injection sites.
Use caution with activities that increase bleeding risk.

Special Considerations

Black Box Warnings:

Risk of spinal or epidural hematoma, which may result in long-term paralysis when used in patients receiving neuraxial anesthesia or with spinal puncture.

Genetic Factors: Consider genetic factors affecting bleeding risk.

Lab Test Interference: May slightly affect aPTT and anti-Xa levels.

Overdose Management

Signs/Symptoms: Excessive bleeding, anemia, hypotension.

Treatment: Discontinue medication, apply pressure to bleeding sites, administer Protamine sulfate if indicated (though partial reversal for LMWHs like tinzaparin is possible). Supportive care and blood products as needed.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C, away from light and moisture.

Stability: Stable until the expiration date on the packaging.