Τίτλος:
Tinzaparin Safety in Patients With Cancer and Renal Impairment: A Systematic Review
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Low-molecular-weight heparins are approved for primary and secondary venous thromboembolism prevention. Tinzaparin is the low-molecular-weight heparin with the highest average molecular weight. The purpose of this systematic review is to provide an update regarding the safety profile of tinzaparin, prescribed either as a prophylactic or as a therapeutic regimen for venous thromboembolism in special populations, including cancer patients and patients with renal impairment. We identified prospective studies up to August 2020 reporting safety outcomes for cancer patients and patients with renal impairment on tinzaparin regimens. In patients with cancer major bleeding rates fluctuated between 0.8% and 7%. Patients on tinzaparin exhibited significantly lower rates of clinically relevant nonmajor bleeding events in comparison with those on vitamin K antagonists. Bioaccumulation of tinzaparin was not correlated with age, body weight or creatinine clearance. Periodic administration of either prophylactic or therapeutic doses of tinzaparin did not result in bioaccumulation, even in patients with severe renal impairment and creatinine clearance < 20 ml/min. Major bleeding rates for non-cancer patients with renal impairment on prophylactic tinzaparin regimens were 0%. Non-cancer patients with renal impairment on therapeutic tinzaparin regimens exhibited major bleeding in 0 to 3.4% of cases; major bleeding rates were higher for cancer patients with renal impairment on therapeutic tinzaparin regimens (4.3 to 10%). Tinzaparin can be used without dose adjustment in patients with severe renal impairment and creatinine clearance > 20 ml/min. Tinzaparin represents a safe choice for special populations at increased risk for thrombosis and bleeding. © The Author(s) 2021.
Συγγραφείς:
Vathiotis, I.A.
Syrigos, N.K.
Dimakakos, E.P.
Περιοδικό:
Clinical and Applied Thrombosis/Hemostasis
Εκδότης:
SAGE Publications Inc.
Λέξεις-κλειδιά:
acenocoumarol; enoxaparin; heparin; rivaroxaban; tinzaparin; warfarin; anticoagulant agent; tinzaparin, adult; aged; anticoagulation; bioaccumulation; bleeding; body weight; cancer patient; chronic kidney failure; creatinine clearance; drug efficacy; drug safety; estimated glomerular filtration rate; hemodialysis; heparin induced thrombocytopenia; human; interrater reliability; major clinical study; malignant neoplasm; personalized medicine; pharmacokinetics; randomized controlled trial (topic); renal impairment; Review; systematic review; thrombocytopenia; venous thromboembolism; bleeding; complication; female; kidney failure; male; neoplasm; primary prevention; prospective study; safety; secondary prevention; venous thromboembolism, Anticoagulants; Female; Hemorrhage; Humans; Male; Neoplasms; Primary Prevention; Prospective Studies; Renal Insufficiency; Safety; Secondary Prevention; Tinzaparin; Venous Thromboembolism
DOI:
10.1177/1076029620979592
