Tinzaparin use in pregnancy: an international, retrospective study of the safety and efficacy profile

Nelson‐Piercy, Catherine; Powrie, Raymond; Borg, J.Y.; Rodger, Marc; Talbot, David J.; Stinson, J.; Greer, Ian A.

doi:10.1016/j.ejogrb.2011.08.005

Cited by 66 publications

(70 citation statements)

References 17 publications

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“…There was a small statistically significant reduction in the MA of A heparin effect (defined as a TEG R time >25% longer than a heparinase corrected control R 205 time) was only identified in three women in the study (Table 2) associated with a very low incidence of both postpartum and antenatal VTE. 16,17 It is more 232 plausible that although we used the recommended thromboprophylactic dose of tinzaparin in 233 these women, that this dose was insufficient to produce a change in TEG parameters. Our 234 study findings do not affirm that tinzaparin has no anticoagulant activity and a significantly 235 larger sample size would be needed to assess anticoagulant effects in more detail.…”

mentioning

confidence: 99%

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Griffiths

Woo

Mansoubi

et al. 2017

International Journal of Obstetric Anesthesia

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mentioning

confidence: 99%

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Griffiths

Woo

Mansoubi

et al. 2017

International Journal of Obstetric Anesthesia

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“…For this and legal reasons, drugs are frequently considered to be contraindicated during [5]. There were no cases of fatal bleeding, but medical intervention due to severe bleeding was required in 3.4 % of the cases.…”

Section: Maternal Risks Of Anticoagulationmentioning

confidence: 99%

“…Heparins do not cross the placenta and therefore have no impact on the risk of foetal bleeding [8,101,102]. There is also no evidence indicating that teratogenicity results from the use of LMWH or UFH during pregnancy [5,65,103]. Because it has a high molecular weight and a negative charge, UFH also does not appear in breast milk.…”

Section: Foetal Risks Of Anticoagulationmentioning

confidence: 99%

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann

Scholz

Rott

et al. 2016

Vasa

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Summary: Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational studies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefi t. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and defi ne the optimal duration and intensity of anticoagulant treatment. Anticoagulant therapy during pregnancyLow-molecular-weight heparins (LMWH) are considered the anticoagulants of choice in pregnancy-associated VTE because LMWH do not cross the placenta and do not appear at signifi cant levels in breast milk. Although a Cochrane Review stated that there was no evidence from randomised controlled trials regarding the effi cacy of anticoagulant therapy for DVT in pregnancy [2], two systemic reviews of LMWH use in pregnant women have confi rmed their efficacy and safety, which were consistent with those in nonpregnant women [3,4]. Compared to unfractionated heparin (UFH), LMWH were associated with a substantially lower risk of adverse side eff ects, such as heparin-induced thrombocytopenia (HIT), haemorrhage, and osteoporosis [3 -7]. However, UFH may be considered an alternative if LMWH cannot be used or if UFH seems to be advantageous over LMWH, e.g., in women at high risk of bleeding complications or in women with severe renal impairment. Women with confi rmed PE and haemodynamic compromise who are candidates for subsequent thrombolysis should also receive UFH during the initial phase until defi nitive treatment decisions are reached [1]. Data obtained from non-pregnant patients have confi rmed that LMWH are at least as eff ective...

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“…During pregnancy, there is limited reported experience to support the use of this drug at therapeutic doses [20,21,22]. The main objective of this study was to retrospectively assess the safety of therapeutic doses of tinzaparin (175 IU/kg/day) administered once daily for the treatment of VTE during pregnancy at 3 tertiary care centres in France.…”

Section: Introductionmentioning

confidence: 99%

Safety of Therapeutic Doses of Tinzaparin During Pregnancy

Parent

Deruelle²,

Sanchez

et al. 2015

Gynecol Obstet Invest

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Background/Aims: Low molecular weight heparin is recommended for the treatment of venous thromboembolism (VTE) during pregnancy. However, there are few reliable data regarding the safety of therapeutic doses of tinzaparin in this setting. The objective of this study was to assess the safety of once-daily therapeutic doses of tinzaparin for the treatment of VTE during pregnancy. Methods: A retrospective study was carried out in 3 tertiary care centres in France, from 1998 to 2009, including consecutive pregnant women who received once-daily therapeutic doses of tinzaparin (175 IU/kg/day). Results: We analyzed 87 pregnancies in 83 women, representing a total of 13,320 patient-days of treatment. Live-birth rate was 97.8%, with one case of miscarriage (<20 weeks of gestation) and one case of intrauterine foetal death (≥20 weeks). There was no antenatal major bleeding. Major bleeding occurred in 4 women during an emergency caesarean section. No case of heparin-induced thrombocytopenia and no maternal death were reported. There was no neonatal haemorrhage and no case of congenital abnormality. VTE recurred on treatment in one patient and after treatment interruption for several days in 2 other patients. Conclusions: These results support the safety of once-daily tinzaparin at therapeutic dose for the treatment of VTE during pregnancy.

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Tinzaparin use in pregnancy: an international, retrospective study of the safety and efficacy profile

Cited by 66 publications

References 17 publications

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Safety of Therapeutic Doses of Tinzaparin During Pregnancy

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