Tinzaparin Prescribing Advice: VTE Prophylaxis and Treatment in Adults

All prescriptions must state: INDICATION, WEIGHT, eGFR and DOSE in units (in full) & mL

General Information Prophylaxis Use Syringes 10,000 units/mL Treatment Use syringes 20,000 units/mL
Use Syringes 20,000 units/mL eGFR less than 20 mL/minute/: give first dose and seek advice

Contra-indications Medical and Surgical patients For ALL patients including in pregnancy
Patients with one or more VTE risk factors Dose 175 units/kg body weight ONCE daily (rounded to nearest 1000 units)
l Activebleeding
l Acquired bleeding disorder
Body weight eGFR eGFR Body weight ONCE Injection Syringe size
(eg acute liver failure) ≥ 20 mL/minute < 20 mL/minute Booking weight Daily dose volume and colour
l Uncontrolled systolic hypertension in pregnancy
(>230/120 mmHg) 31 – 49kg 2500 units 0.25mL 2500 units 0.25mL
ONCE daily ONCE daily kg units mL
l Activepeptic ulcer disease or risk of
GI haemorrhage 40 - 44 7,000 0.35 Red
l Thrombocytopenia 50 - 130kg 4500 units 0.45mL 3500 units 0.35mL 45 - 49 8,000 0.40 10,000 units
(platelets less than 75x109/L) ONCE daily ONCE daily in 0.5mL
50 - 54 9,000 0.45
l Untreated inherited bleeding disorder
eg haemophilia, von Willebrand disease Less than 30kg or Consider 50 units/kg ONCE daily 55 - 59 10,000 0.50
l Acute stroke more than 130 kg Reduce dose if eGFR < 20 mL/minute
60 - 64 11,000 0.55 Yellow
l Previous heparin induced thrombocytopenia 14,000 units
Obstetrics patients 65 - 69 12,000 0.60
l Sensitivity to heparin In 0.7mL
eGFR <20 mL/minute: discuss with consultant haematologist 70 - 74 13,000 The0.65
Rotherham
l Bacterial endocarditis
Body weight Dose Syringe colour 75 -79 13,000 0.65Foundation Trust
NHS
l Taking anticoagulants known to increase INR >2 Booking weight
80 - 84 14,000 0.70
Less than 50kg 3500 units 0.35mL Green 85 - 89 15,000 0.75 Blue
Prescriptions for Tinzaparin must state ONCE daily
l Indication eg DVT treatment 90 - 94 16,000 0.80 18,000 units
l Weight In 0.9 mL
95 - 99 17,000 0.85
l eGFR 50 - 90kg 4500 units 0.45mL Pale blue
l Dose in units and mL ONCE daily 100 - 104 18,000 0.90
l Route subcutaneous 105 - 109 19,000 0.95 Red
If continued by GP, inform GP of above and duration Two syringes
91 - 130kg 3500 units 0.35mL Green 110 - 114 20,000 1.00
10,000 units
TWICE daily 115 - 119 20,000 1.00
Review / Monitoring Requirements: in 0.5 mL

Prophylaxis 120 - 124 21,000 1.05 Yellow

Review within 24 hours and whenever 131 - 170kg 4500 units 0.45mL Pale blue Two syringes
TWICE daily
125 - 129 22,000 1.10
the condition changes 14,000 units
130 - 134 23,000 1.15 In 0.7mL
Treatment 135 - 139 24,000 1.20
l Plateletcounts on day 1, 5 and 10 More than 170kg 7000 units 0.35mL Red
TWICE daily 140 - 144 25,000 1.25
l Potassium

Renal impairment: Monitor High prophylactic 4500 units 0.45mL Pale blue Less than 40 kg =175 x body wt 175 x body wt
l Renal function closely (intermediate) TWICE daily or = 20000
dose for women More than145 kg Units ONCE daily
l Signs of bruising and bleeding mL ONCE daily
50 - 90 kg

For advice on doses: 0900 - 1700 Medicines Information (Ext 4126); 1700 – 1900 Pharmacy Dispensary (Ext 4469); 1900 – 0900 Consultant Haematologist on call V7 Issue February 2015 Review February 2017