Tinzaparin sodium

Tinzaparin sodium

n = 1 to 25, R = H or SO3Na, R1 = H, SO3Na or COCH3, R2 = H and R3 = COONa or R2 = COONa and R3 = H
Clinical data
Trade names Innohep
AHFS/Drugs.com Monograph
Routes of
subcutaneous (once daily)
ATC code B01AB10 (WHO)
Pharmacokinetic data
Bioavailability 90% for Anti-Xa activity, 67% for Anti-IIa activity)[1]
Metabolism primarily by liver by desulfation and/or depolymerization
Biological half-life 200 min. for Anti-Xa activity, 257. min for Anti-IIa activity [2]
CAS Number 9041-08-1 N
[9041-08-1] (sodium salt)
KEGG D07510 YesY
Chemical and physical data
Molar mass 6500 g/mol (average)[3]
 NYesY (what is this?)  (verify)

Tinzaparin is an antithrombotic drug in the heparin group. It is a low molecular weight heparin (LMWH) marketed as Innohep worldwide. It has been approved by the U.S. Food and Drug Administration (FDA) for once daily treatment and prophylaxis of deep vein thrombosis and pulmonary embolism.[4]

It can be given subcutaneously by syringe, or intravenously.[5] It was manufactured by Leo pharmaceutical company, who withdrew the product from the US in 2011 due to low sales and a contamination issue.[6]

Use in elderly

In July 2008, the company revised the prescribing information to restrict the use of tinzaparin in patients 90 years of age or older. FDA is concerned that the preliminary data from the IRIS study suggests that the increased risk of mortality is not limited only to patients 90 years of age or older.

According to the study Innohep increases the risk of death for elderly patients (i.e., 70 years of age and older) with renal insufficiency. Healthcare professionals should consider the use of alternative treatments to Innohep when treating elderly patients over 70 years of age with renal insufficiency and DVT, PE, or both.

Use in pregnancy

No LMWH, except tinzaparin, is licensed for use in gestational hypercoagulability.[7] Still, tinzaparin is often the LMWH of choice in pregnant women.[7]

Side effects

Bleeding in overdose. There is occasionally bruising at the site of injection.


Tinzaparin does not affect the international normalized ratio (INR), prothrombin time (PT). Anti-factor Xa levels can be measured, and are often used to monitor tinzaparin.

Reversal agent

Protamine sulfate will reverse Tinzaparin by 85% per package insert.


  1. Cheer S.M. et al. Drugs 2004; 64 (13): 1479–1502
  2. Pedersen P.C. et al. Thromb Res 1991; 61 (5-6): 477-487
  3. European Pharmacopoeia, 6th Edition, 2008
  4. Hull et al. NEJM 1992;326,15:975-982
  5. Farmaceutiska Specialiteter i Sverige - the Swedish official drug catalog. Fass.se > Innohep
  6. http://www.ashp.org/menu/DrugShortages/DrugsNoLongerAvailable/Bulletin.aspx?id=749
  7. 1 2 Therapeutic anticoagulation in pregnancy. Norfolk and Norwich University Hospital (NHS Trust). Reference number CA3017. 9 June 2006 [review June 2009]

External links

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