When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.
The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants. The risk also appears to be increased by traumatic or repeated epidural or spinal puncture.
Patients should be frequently monitored for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.
The physician should consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis (see also WARNINGS, Hemorrhage, and PRECAUTIONS, Drug Interactions).
Media Articles Related to Innohep (Tinzaparin)
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Quiz
Source: MedicineNet Deep Vein Thrombosis Specialty [2014.08.20]
Title: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Quiz
Category: MedicineNet Quiz
Created: 7/31/2014 6:52:00 PM
Last Editorial Review: 8/20/2014 8:00:44 PM
Deep Vein Thrombosis (DVT)
Source: MedicineNet Antiphospholipid Syndrome Specialty [2013.11.29]
Title: Deep Vein Thrombosis (DVT)
Category: Diseases and Conditions
Created: 2/15/2000 10:55:00 PM
Last Editorial Review: 11/29/2013 12:00:00 AM
Published Studies Related to Innohep (Tinzaparin)
Safety profile of tinzaparin versus subcutaneous unfractionated heparin in elderly patients with impaired renal function treated for acute deep vein thrombosis: the Innohep(R) in Renal Insufficiency Study (IRIS). [2011.07]
INTRODUCTION: Trials comparing the use of full dose unfractionated heparin (UFH) or low molecular weight heparins (LMWHs) in very elderly patients with impaired renal function are lacking. IRIS aimed to assess whether LMWH is at least as safe as UFH in this population... CONCLUSION: The IRIS study was a challenging study involving patients (mean age 83 years) usually excluded from clinical studies, but its early termination has left questions unanswered. The mortality difference observed with tinzaparin vs. UFH in elderly, renally-impaired patients with DVT cannot be explained on the basis of bleedings or recurrent VTE, and may reflect an imbalance of mortality risk factors at baseline. Copyright (c) 2011. Published by Elsevier Ltd.
[Effect of tinzaparin on survival in non-small-cell lung cancer after surgery. TILT: tinzaparin in lung tumours]. [2011.05]
BACKGROUND: Experimental and clinical findings suggest that low molecular-weight heparins may improve overall survival in patients with cancer...
Relationship between baseline blood pressure parameters (including mean pressure, pulse pressure, and variability) and early outcome after stroke: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). [2011.02]
BACKGROUND AND PURPOSE: High blood pressure (BP) in acute stroke is associated independently with a poor outcome. Recent evidence suggests that other hemodynamic parameters may also be associated with outcomes following stroke... CONCLUSIONS: Early death or neurologic deterioration, deterioration, and recurrent stroke are associated independently with high systolic BP, mean arterial pressure, pulse pressure, and BP variability. These measures offer potential therapeutic targets for improving early outcome after acute ischemic stroke.
Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis. [2010.12.06]
BACKGROUND: Low molecular weight (LMW) heparins are used for anticoagulation during hemodialysis (HD). Studies in animals have shown that LMW-heparins release lipoprotein lipase (LPL) as efficiently as unfractionated (UF) heparin, but are less able to retard hepatic uptake of the lipase. This raises a concern that the LPL system may become exhausted by LMW-heparin in patients on HD. We have explored this in the setting of clinical HD... CONCLUSION: Our data demonstrate that repeated HD with UF-heparin or tinzaparin does not exhaust the LPL-system.
Asymptomatic hemorrhagic transformation of infarction and its relationship with functional outcome and stroke subtype: assessment from the Tinzaparin in Acute Ischaemic Stroke Trial. [2010.12]
BACKGROUND AND PURPOSE: Asymptomatic hemorrhagic transformation of infarction (AHTI) is common, but its risk factors and relationship with functional outcome are poorly defined... CONCLUSIONS: AHTI is increased in ischemic stroke with cortical syndromes and of large vessel or cardioembolic etiology. Heparin does not increase AHTI. AHTI is not associated with functional outcome.
Clinical Trials Related to Innohep (Tinzaparin)
Long-Term Innohep´┐Ż Treatment Versus a Vitamin K Antagonist (Warfarin) for the Treatment of Venous Thromboembolism (VTE) in Cancer [Recruiting]
The purpose of this study is to assess the efficacy and safety of Innohep┬« in preventing the
recurrence of VTE in patients with active cancer who have had an acute VTE episode.
Use of Low Molecular Weight Heparin (Tinzaparin) to Treat Blood Clots in Patients With Kidney Failure [Recruiting]
Blood clots in the leg veins, known as deep vein thrombosis, are important because they may
travel to the lung (known as pulmonary embolism) and cause death. Blood clots are treated
with blood thinners, or anticoagulants. The preferred treatment is an anticoagulant known
as low molecular weight heparin (LMWH). LMWH is given by an injection under the skin, which
is convenient for patients because they can self-administer this medication at home, and no
blood testing is required. However, LMWH is cleared from the body through the kidneys, so
patients who have kidney failure are generally not treated with LMWH because they may be at
a higher risk of bleeding.
One type of LMWH, known as tinzaparin, may be less dependent on the kidneys for clearance
and may not increase in patients with kidney failure. The investigators would like to use
tinzaparin to treat patients who have deep vein thrombosis or pulmonary embolism, and who
also have kidney failure.
The purpose of this study is to determine whether the blood thinning effects of tinzaparin
build up, or accumulate, in patients with varying degrees of kidney failure compared to
patients without kidney failure. The blood thinning effects will be measured using a blood
test known as an anti-Xa level. Patients will be followed over the time they receive
tinzaparin and those patients who are found to have potentially high levels of tinzaparin
(based on the anti-Xa level) will have their tinzaparin dose adjusted. The investigators
believe that the levels of tinzaparin will not accumulate to potentially dangerous levels in
a significant number of patients with kidney failure.
Safety and Efficacy of Therapeutic Anticoagulation With Tinzaparin During Pregnancy Via Weight-based Dosing [Recruiting]
The purpose of this study is to evaluate the safety and efficacy of therapeutic
anticoagulation with tinzaparin during pregnancy via weight-based dosing.
Extended Peri-operative Tinzaparin to Improve Disease-free Survival in Patients With Resectable Colon Cancer [Recruiting]
The human body has a natural stress response to surgery, including the formation of blood
clots. This response to surgery has been shown to increase metastases (the spread of cancer
cells to other organs in the body). These metastases cannot be seen at the time of surgery
but when they grow into new tumors, the cancer has recurred (come back). A blood thinner
called "low molecular weight heparin" (LMWH) can suppress the development of metastases
after surgery in animal experiments. The investigators want to see if giving patients with
colon cancer the blood thinner, LMWH, around the time of surgery can decrease the chance of
their cancer spreading to other organs (metastases) and coming back (recurrence).
The investigators need 1075 patients to answer our scientific question. Patients who give
informed consent will be randomly put into one of two groups, the experimental group and the
control group. The patients in the control group will be treated with LMWH starting a few
hours after surgery and every day until they leave the hospital. This is how most patients
are treated after colon cancer surgery (standard care). The patients in the experimental
group will be treated with LMWH for a longer period of time, starting on the day they agree
to have surgery and continuing for two months after surgery. All the patients will be
followed for at least three years after surgery to find out if their cancer has recurred
(come back). If LMWH treatment around the time of surgery reduces the chance of recurrence
in patients with colon cancer, it would improve the health and quality of life for these
Tinzaparin in the Treatment of the Acute Pulmonary Embolism [Recruiting]
The purpose of this study is to evaluate the feasibility of the long-term treatment of
pulmonary embolism with tinzaparin compared to oral anticoagulants.
Reports of Suspected Innohep (Tinzaparin) Side Effects
Pulmonary Embolism (28),
OFF Label USE (26),
Drug Ineffective (20),
Deep Vein Thrombosis (14),
Thrombosis in Device (13),
Incorrect Drug Administration Duration (13),
Maternal Exposure During Pregnancy (12),
Haemoglobin Decreased (11),
Haematoma (9), more >>