Classification : Low molecular weight heparins

Prevention  & treatment of venous thromboembolism[8]

Prevent clotting during extracorporeal circulation ( haemodialysis )

Treatment of acute symptomatic deep vein thrombosis[6]

Used to prevent blood clot in haemodailysis or haemofiltration[8]

Prophylaxis of deep vein thrombosis(DVT) during general surgeries[8]

The route of administration is subcutaneous injection.

For adult, the dose is 175 anti-Xa units/kg once daily for more than 6 days and until patient is adequately anticoagulated with warfarin. [28]

• Bleeding ( haemorrhage ) esp with slow IV injection of protamine sulphate[14]

• 
  Increase in liver enzymes / ALT & AST

• 
  injection site hematoma

• 
  may cause urinary tract infection[13]

i. Tinzaparin – Aspirin
Effect of Tinzaparin is enhanced by intake of aspirin, which lead to bleeding risk[4]

ii. Tinzaparin – Glyceryl trinitrate
Tinzaparin anticoagulant effect is reduced with infusion of glyceryl trinitrate[4]

iii. Tinzaparin – Diclofenac
Increased risk of Hemorrhage when using Tinzaparin together with intravenous diclofenac[4]

iv. Tinzaparin – Angiotensin-II receptor antagonist
Usage of Tinzaparin with angiotensin-II receptor antagonist lead to increased risk of hyperkalemia[4]

Dose depends on uses

For treatment of venous thromboembolism, dose 175 units/kg by sc injection once daily until optimum anticoagulant effect[8]

For haemodialysis, it is given together with 0.9% NaCl 500-1000ml containing Tinzaparin sodium 5000 unit / L
Patients with recent or anticipated epidural or spinal anesthesia are at risk of spinal & epidural hemitoma and consequent paralysis when using this drug[13]

Use with care in patients with renal failure; creatinine clearance < 30ml/minute or had a 24% decrease in clearance[13]

Caution in pregnancy and children use as the safety and efficacy of Tinzaparin is yet to established[6]

High bleeding risk in renal patient[6]

Fatal gasping syndrome caused by Benzyl alcohol, preservative used in tinzaparin[6]

Allergic reaction caused by sodium metabisulphate, stabilizer used in tinzaparin[6]