Safety Profile of Tinzaparin Administered Once Daily at a Standard Curative Dose in Two Hundred Very Elderly Patients

Pautas, Éric; Gouin, I.; Bellot, Oliver; Andreux, J.‐P.; Siguret, Virginie

doi:10.2165/00002018-200225100-00005

Cited by 87 publications

(63 citation statements)

References 35 publications

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“…81 In addition, tinzaparin, unlike enoxaparin, did not accumulate when used as VTE prophylaxis for 8 days in elderly patients with a mean C cr of 35 mL/min, 97 or in elderly patients (age >70 years) with renal insufficiency (but C cr >20 mL/min) receiving therapeutic doses of tinzaparin (175 IU/kg daily) for 10 days. 98,99 However, results from a randomized clinical trial of elderly patients with a C Cr level less than 60 mL/min undergoing initial treatment for VTE showed a substantially higher mortality rate in the arm receiving tinzaparin than in the group receiving unfractionated heparin (UFH; 11.2% vs 6.3%; P=.049). 100 Although the rates of bleeding and recurrent VTE did not differ between the arms, the trial was terminated early, and the panel recommends that tinzaparin be avoided in patients aged 70 years and older with renal insufficiency.…”

Section: Therapies For Prophylaxis or Treatment Of Vte In Patients Wimentioning

confidence: 99%

Venous Thromboembolic Disease

Streiff¹,

Bockenstedt²,

Cataland³

et al. 2013

J Natl Compr Canc Netw

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OverviewVenous thromboembolism (VTE) is a common and life-threatening condition in patients with cancer.1,2 Results from a retrospective study of hospitalized adult patients with cancer with neutropenia (N=66,106) showed that approximately 3% to 12% of these patients, depending on the type of malignancy, experienced VTE during their first hospitalization.1 In a recent health claims database analysis of patients undergoing chemotherapy for solid tumors in the ambulatory setting (N=17,284), VTE NCCN Venous Thromboembolic Disease Clinical Practice Guidelines in Oncology AbstractVenous thromboembolism (VTE) remains a common and life-threatening complication among patients with cancer. Thromboprophylaxis can be used to prevent the occurrence of VTE in patients with cancer who are considered at high risk for developing this complication. Therefore, it is critical to recognize the various risk factors for VTE in patients with cancer. Risk assessment tools are available to help identify patients for whom discussions regarding the potential benefits and risks of thromboprophylaxis would be appropriate. The NCCN Clinical Practice Guidelines in Oncology for VTE provide recommendations on risk evaluation, diagnosis, prevention, and treatment of VTE in patients with cancer. (JNCCN 2013;11:1402-1429 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Therapies For Prophylaxis or Treatment Of Vte In Patients Wimentioning

confidence: 99%

Venous Thromboembolic Disease

Streiff¹,

Bockenstedt²,

Cataland³

et al. 2013

J Natl Compr Canc Netw

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“…Patients who used enoxaparin and presented bleeding were younger than those who did not bleed, differently from previous reports where risk of bleeding with LMWH was higher in older people. 36,37 We have to consider that severity of disease was higher in the subgroup that had bleeding, yet it was not detected clinically by APACHE II score.…”

Section: Enoxaparin Vs Unfractioned Heparin In Cvvhd 325mentioning

confidence: 99%

Enoxaparin versus unfractioned heparin as anticoagulant for continuous venovenous hemodialysis: a randomized open-label trial

et al. 2010

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Aim: In this study we aimed to compare the efficacy and safety of enoxaparin with unfractioned heparin (UFH) as anticoagulant for continuous venovenous hemodialysis (CVVHD). Methods: An open-label randomized controlled trial was carried out in an intensive care unit (ICU) where 40 patients with acute renal failure (ARF) who needed continuous renal replacement therapy were randomized to receive UFH (n = 21) or enoxaparin (n = 19). Coagulation parameters were evaluated, and antithrombotic activity of UFH was measured by activated partial thromboplastin time (aPTT) and for enoxaparin by anti-factor Xa activity. Primary outcomes were thrombosis of the extracorporeal circuit and bleeding, classified as major or minor. Results: Minor bleeding episodes were observed only in patients anticoagulated with enoxaparin (26 vs. 0%, p = 0.018). Comparing patients with or without bleeding after 24 hours of therapy, the level of anticoagulation tended to be higher (anti-factor Xa: 1.62 vs. 1.13 IU/mL, p = 0.09) and the platelet count to be lower [107 ± 53 vs. 229 ± 84 (×10 3 /μL), p = 0.09] in patients who bled, but without statistical difference. Filter life span of enoxaparin and UFH groups was similar (43 ± 15 vs. 52 ± 18 hr, p = 0.10), as well as the proportion of circuit clotting. Conclusion: Weightunadjusted enoxaparin in patients with ARF in CVVHD was associated with an increased rate of bleeding, a finding that addresses the need to adjust drug dose and to monitor anti-factor Xa activity during dialysis. No benefit to prolong dialysis circuit survival was found with enoxaparin. In patients who do not present contraindication for systemic anticoagulation, UFH remains an effective and low-cost option.

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“…Only three major bleeding episodes (1.5%) occurred, two of them being likely due to multidrug interactions. Considering six reported fatal cases, only one (0.5%) could be related to the anticoagulant treatment in this fragile population [23].…”

Section: Cancer Patients Use Of Lmwh and Renal Impairmentmentioning

confidence: 84%

“…The IRIS trial (N=542) explored elderly patients aged ≥ 75 years with creatinine clearance ≤ 60 mL/min or ≥ 70 years with creatinine clearance ≤ 30 mL/ min [23]. Tinzaparin or UFH were given during the first 5 days.…”

Section: Cancer Patients Use Of Lmwh and Renal Impairmentmentioning

confidence: 99%