Tinzaparin Injection Pre-filled Syringe

Low molecular weight heparin

The Formulary choice of LMWH for both Sheffield and Doncaster Acute Trusts is Dalteparin, refer to Shared Care Protocol

NICE NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

Acute Trusts in other areas may operate a shared care system for other LMWH's. Primary Care may wish to consider engaging in this system providing appropriate paperwork is sent from the initiaing prescriber to support this.

Rotherham Patients:
Rotherham Hospital is currently using Tinzaparin as it's LMWH and is in the process of developing it's own Shared Care documentation.

Ensure a completed transfer form is received from the initiating prescriber to fulfill the NPSA Guidance listed below:

When transferring prescribing from Secondary to Primary Care it is essential that the following information, in line with NPSA guidance, is made available to healthcare professionals involved in prescribing, dispensing and administration:

1. A patient's weight is used as the basis for calculating the required treatment dose of LMWH. The weight must be accurately recorded in kilograms (kg) in the inpatient medication chart (when in use) and clinical record. Patients should be weighed at the start of therapy and, where applicable, during treatment.
2. Renal function is considered when prescribing treatment doses of LMWHs. The renal function test should not delay initiation of the first dose but every effort must be made to base subsequent dosing on these results.
3. Dose calculation tools are available for a range of body weights, specific clinical indications and LMWH products, and that consideration is given to rationalising the range of LMWH products used in the organisation.
4. Essential information such as dose, weight, renal function, indication and duration of treatment is communicated at transfers of care (e.g. by discharge letters) and used to ensure that future doses are safe.
5. Dosing checks based on patient information are made by healthcare professionals who review, dispense or administer LMWHs when this information is readily available to them.

NPSA Rapid Response Report/2010/RRR/014 - Reducing treatment dose errors with low molecular weight heparins July 2010

In terms of pharmacological prophylaxis for VTE, NICE recommend the following:
* Offer pharmacological VTE prophylaxis to general medical patients assessed to be at increased risk of VTE. Choose any one of fondaparinux sodium, low molecular weight heparin (enoxaparin, tinzaparin, daltaparin) or unfractionated heparin (for patients with renal failure)
* Start pharmacological VTE prophylaxis as soon as possible after risk assessment has been completed.
* Continue until the patient is no longer at increased risk of VTE.

Low molecular weight heparin

Brand: Clexane, Arovi

The Formulary choice of LMWH for both Sheffield and Doncaster Acute Trusts is Dalteparin, refer to Shared Care Protocol 

Acute Trusts in other areas may operate a shared care system for other LMWH's. Primary Care may wish to consider engaging in this system providing appropriate paperwork is sent from the initiating prescriber to support this.

Rotherham Patients:
Rotherham Hospital is currently using Tinzaparin as it's LMWH and is in the process of developing it's own Shared Care documentation.

Maintaining patency of peripheral venous catheters

Brand: Hepsal, Monoparin

Evidence reviewed by UK Medicines Information (UKMi) confirms that Heparin flushes should not normally be used to flush peripheral intravenous catheters.

All flush solutions should only be administered following a prescription or patient group direction.

Organisations should review local policies to minimise the use of heparin flush solutions in all devices, including complex central venous or arterial catheters.

NPSA Rapid Response Report 24th April 2008

VTE - Prophylaxis of venous thromboembolism in surgery of patients with congenital antithrombin deficiency

Rationale: 1,6

Anticoagulation of patients with heparin-induced thrombocytopenia type II requiring parenteral antithrombotic therapy

Rationale: 1,6

All licensed indications

Rationale 1,6

Brand - Fragmin

Treatment of symptomatic venous thromboembolism in paediatric patients aged ≥1 month

Pulmonary arterial hypertension, to prevent blood clotting during kidney dialysis in emergency situations                                     

Renal dialysis

Rationale: 1,6

Acute DVT and PE, and prevention of VTE in high-risk patients. Acute symptomatic spontaneous superficial vein thrombosis of the lower limbs without concomitant deep vein thrombosis

Rationale 1

NICE CG92 Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital January 2010

All licensed indications

Brand : Zibor

Rationale 1

Bemiparin cannot be recommended for prescribing: alternative therapies are available for which the evidence and efficiacy is much stronger.
MTRAC Verdict
October 2008