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Ersin Ozaslan, Metin Ozkan, Irfan Cicin, Mustafa Benekli, Murat Kocer, Mukremin Uysal, Berna Oksuzoglu, Abdurrahman Isikdogan, Erdem Cubukcu, Emin T Elkiran, Faysal Dane, Mehmet Aliustaoglu, Alper Sevinc, Aziz Karaoglu, Arife Ulas, Gamze Gokoz-Dogu
We compared the efficacy and safety of low-molecular-weight heparins (LMWHs) in patients with cancer who are at low risk of venous thromboembolism (VTE). Patients were treated by medical oncologists in Turkey at 15 sites, where they were enrolled and followed up for a period of 12 months. Due to the study design, there was no specific treatment protocol for LMWH. Primary end points were efficacy and the time to change in VTE status. Of the included 250 patients, 239 (95.6%), 176 (70.4%), 130 (52.0%), and 91 (36...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Maram B Hakoum, Lara A Kahale, Ibrahim G Tsolakian, Charbel F Matar, Victor Ed Yosuico, Irene Terrenato, Francesca Sperati, Maddalena Barba, Holger Schünemann, Elie A Akl
BACKGROUND: Compared with people without cancer, people with cancer who receive anticoagulant treatment for venous thromboembolism (VTE) are more likely to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the initial treatment of VTE in people with cancer. SEARCH METHODS: A comprehensive search included a major electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 1), MEDLINE (via Ovid) and Embase (via Ovid); handsearching of conference proceedings; checking of references of included studies; use of the 'related citation' feature in PubMed; and a search for ongoing studies...
January 24, 2018: Cochrane Database of Systematic Reviews
Athanasios Giannoukas, Christos Karathanos, Konstantinos Nikolakopoulos, Georgiadis S George, Chrisostomos Maltezos, Christos Ioannou, Spyros Vasdekis, Georgios Trelopoulos
Objectives Low-molecular-weight heparins are recommended in the treatment of superficial vein thrombosis but with low grade of evidence. This study was conducted to assess the treatment outcomes of acute superficial vein thrombosis with intermediate dose of Tinzaparin. Methods Retrospective analysis of records from outpatients over a period of 16 months treated in seven centers with Tinzaparin 0.5 ml (10,000 anti-Xa IU) once daily for a period that was at the treating physician's discretion. All the patients were followed up for at least 12 weeks...
January 1, 2017: Phlebology
Jennifer Purnell, Alym N Abdulla
Low-molecular-weight heparin (LMWH) therapy has recently been proposed as a cause of ischemic priapism. The evidence, however, remains scarce, as there are very few published cases of LMWH-induced priapism to date. The implications of such events are significant as ischemic priapism is a medical emergency. In current clinical practice we are seeing a trend towards LMWH therapies replacing unfractionated heparin (UFH). As LMWH therapies continue to gain favor, we will potentially see more cases of LMWH-induced priapism...
December 8, 2017: International Journal of Impotence Research
Malin S E Skagerlind, Bernd G Stegmayr
INTRODUCTION: Intensive care participants that need dialysis frequently suffer from increased risk of bleeding. Standard intermittent haemodialysis (SHD) includes anticoagulation to avoid clotting of the dialysis system. The aim of this study was to clarify which of four different low-dose anticoagulant modes was preferable in reducing the exposure to i.v. unfractionated heparin (heparin) and maintaining patency of the dialysis circuit. METHODS: Twenty-three patients on SHD were included to perform haemodialysis with four modes of low-dose anticoagulation...
March 2018: European Journal of Clinical Pharmacology
Evangelos P Dimakakos, Ioannis Vathiotis, Konstantinos Syrigos
Current guidelines recommend low-molecular-weight heparin treatment in patients with cancer with established venous thromboembolism (VTE). The aim of this article was to study the pharmacological properties and effectiveness of tinzaparin in patients with cancer as well as its potential anticancer properties. A search of PubMed and ScienceDirect databases up to March 2016 was carried out to identify published studies that detect the properties and use of tinzaparin in oncology. Protamine sulfate partially (60% to 65%) neutralized tinzaparin's anti-Xa activity...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
Anthony Maraveyas, Iqtedar Muazzam, Simon Noble, George Bozas
PURPOSE OF REVIEW: To update on new data for low-molecular weight heparins (LMWHs) and the direct oral anticoagulants (DOACs) for the treatment and prevention of cancer-associated thrombosis (CAT), to discuss progress with the risk-adaptive management scores (RAMS) and update on increased dose primary thromboprophylaxis (IDPTP). RECENT FINDINGS: In a pooled meta-analysis of 1132 cancer patients who received DOACs vs. vitamin K analogues (VKAs), recurrence of venous thromboembolism (VTE) was reduced from 6...
December 2017: Current Opinion in Supportive and Palliative Care
Daniel Bastian Pfankuchen, Fabian Baltes, Tahira Batool, Jin-Ping Li, Martin Schlesinger, Gerd Bendas
Low molecular weight heparin (LMWH), the guideline based drug for prophylaxis and treatment of cancer-associated thrombosis, was recently shown to sensitize cisplatin resistant A2780cis human ovarian cancer cells for cisplatin cytotoxicity upon 24 h pretreatment with 50 μg × mL(-1) of the LMWH tinzaparin in vitro, equivalent to a therapeutic dosage. Thereby, LMWH induced sensitization by transcriptional reprogramming of A2780cis cells via not yet elucidated mechanisms that depend on cellular proteoglycans...
September 15, 2017: Oncotarget
K M Musgrave, K Webber, P Murphy, P Avery, T T Biss
Essentials The once-daily dosing of tinzaparin provides an advantage over other low molecular weight heparins. The recommended age-dependent doses of tinzaparin in children have not previously been validated. Once-daily administration of tinzaparin is a safe and effective treatment of childhood thrombosis. Recommended doses are appropriate but monitoring may be required due to inter-individual variation. SUMMARY: Background The recommended starting doses of tinzaparin for the treatment of thrombosis in children have not previously been validated...
December 2017: Journal of Thrombosis and Haemostasis: JTH
Michail Mitsis, Panagiotis Koliou, Christina Bali, Evangelia Ntounousi, Vasileios Tatsis, Vasileios Nousias, Georgios D Lianos, Georgios Vartholomatos, Dimitrios Nastos
Background/Purpose: In colon cancer (CC) patients preoperative (pre-op) levels of VEGF-A165 (VEGF) is a strong predictor for disease recurrence. Elevated postoperative (post-op) VEGF levels could have undesirable effects by enhancing tumor growth and metastasis formation. It has been suggested that thromboprophylaxis with a Low Molecular Weight Heparin (LMWH) in surgical cancer patients, further to thromboembolic protection, may exert some anti-neoplastic properties, as well. The aim of our study was to assess the potential impact of the LMWH Tinzaparin (Innohep® - Leo Pharma, Copenhagen, Denmark), given at different doses and for different perioperative (peri-op) periods, upon the post-op variability of serum VEGF levels in surgical CC patients...
2017: Journal of Cancer
George Dranitsaris, Lesley G Shane, Seth Woodruff
Background Patients with cancer have an elevated risk of venous thromboembolism. Importantly, patients with cancer, who have metastatic disease, renal insufficiency, or are receiving anticancer therapy, have an even higher risk of a recurrent event. Similarly, the risk of recurrent venous thromboembolism is higher than the risk of an initial event. To reduce the risk, extended duration of prophylaxis for up to six months with low-molecular-weight heparins such as dalteparin, enoxaparin, nadroparin, and tinzaparin is recommended by international guidelines...
January 1, 2017: Journal of Oncology Pharmacy Practice
Juan A Paniagua, Rodrigo Bahamondes, Antonio Cano-Sánchez, Francisco Velasco
In young patients with T1D, neurological manifestations of cerebral hypertension should suggest the possibility of a cerebral venous sinus thrombosis (CVST). In these patients an inherited prothrombotic risk factor, including factor V Leiden G1691A gene mutation, should be considered during an event of thrombosis. Improving the glycemic control is the first factor that should be controlled in a patient who carries a genetic prothrombotic risk factor. Anticoagulant treatment should be started as son as CVST has been diagnosed...
August 2017: Clinical Case Reports
Luis Jara-Palomares, Aurora Solier-Lopez, Teresa Elias-Hernandez, Maribel Asensio-Cruz, Isabel Blasco-Esquivias, Lucia Marin-Barrera, Maria Rodriguez de la Borbolla-Artacho, Juan Manuel Praena-Fernandez, Emilio Montero-Romero, Silvia Navarro-Herrero, Maria Pilar Serrano-Gotarredona, José María Sánchez-Díaz, Carlos Palacios, Remedios Otero
INTRODUCTION: The safety and efficacy of low-molecular-weight heparin (LMWH) treatment in patients with cancer-associated thrombosis (CAT) beyond 6months are unknown. Our aim was to determine the safety of long-term tinzaparin use in patients with CAT. METHODS: We performed a prospective, open, single arm, multicentre study in patients with CAT receiving treatment with tinzaparin. We evaluated the rate of clinically relevant bleeding events (major and non-major clinically relevant bleeding) and venous thromboembolism (VTE) recurrence...
September 2017: Thrombosis Research
Daniel Bastian Pfankuchen, Fabian Baltes, Tahira Batool, Jin-Ping Li, Martin Schlesinger, Gerd Bendas
Low molecular weight heparin (LMWH), the guideline based drug for prophylaxis and treatment of cancer-associated thrombosis, was recently shown to sensitize cisplatin resistant A2780cis human ovarian cancer cells for cisplatin cytotoxicity upon 24 h pretreatment with 50 μg × mL-1 of the LMWH tinzaparin in vitro, equivalent to a therapeutic dosage. Thereby, LMWH induced sensitization by transcriptional reprogramming of A2780cis cells via not yet elucidated mechanisms that depend on cellular proteoglycans. Here we aim to illuminate the underlying molecular mechanisms of LMWH in sensitizing A2780cis cells for cisplatin...
June 28, 2017: Oncotarget
Renske H Olie, Nathalie E L Meertens, Yvonne M C Henskens, Hugo Ten Cate
BACKGROUND: Due to the higher molecular weight of tinzaparin, the low molecular weight heparin (LMWH) is less dependent on renal excretion than other LMWH preparations. However, several international guidelines recommend the same preemptive dosage reduction for all therapeutic dose LMWHs prescribed in renal insufficient patients, to ensure that there is no accumulation of anticoagulant activity and increased risk of bleeding. This study is aimed at assessing whether a preemptive dosage reduction of tinzaparin in all renal insufficient patients (comprising 25% reduction in patients with Modification of Diet in Renal Disease - estimated glomerular filtration rate (MDRD-eGFR) 30-60 mL/min/1...
2017: Nephron
P J Maguire, M McGuire, K A Power, M McNicholl, S R Sheehan, M J Turner
BACKGROUND: National guidelines have been developed to ensure correct dosing of tinzaparin for women delivered by caesarean delivery (CD) to reduce the risk of venous thromboembolism. AIMS: The aim of this study is to examine the impact of implementation of national guidelines on thromboprophylaxis prescribing practice for women undergoing CD in a university maternity hospital. METHODS: Details of tinzaparin usage were obtained from the Hospital pharmacy for the years 2009-2014...
May 4, 2017: Irish Journal of Medical Science
Thomas Mueller, Daniel Bastian Pfankuchen, Kathleen Wantoch von Rekowski, Martin Schlesinger, Franziska Reipsch, Gerd Bendas
Resistance formation of tumors against chemotherapeutics is the major obstacle in clinical cancer therapy. Although low molecular weight heparin (LMWH) is an important component in oncology referring to guideline-based antithrombotic prophylaxis of tumor patients, a potential interference of LMWH with chemoresistance is unknown. We have recently shown that LMWH reverses the cisplatin resistance of A2780cis human ovarian cancer cells in vitro. Here we address the question whether this LMWH effect is also valid under in vivo conditions...
May 3, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
M José Martínez-Zapata, Alexander G Mathioudakis, Shaker A Mousa, Rupert Bauersachs
Patients with cancer are at increased risk of recurrent venous thromboembolism (VTE) and bleeding. Thus, long-term treatment with anticoagulants for secondary prevention is challenging. The objective of this review was to evaluate current evidence on the safety and efficacy of tinzaparin compared with other anticoagulants for long-term VTE treatment in patients with cancer. Based on a preregistered protocol, we identified randomized controlled trials (RCTs) comparing long-term tinzaparin (therapeutic dose: 175 IU/kg) versus other anticoagulants for at least 3 months after an acute episode of VTE that included adult patients with underlying malignancy...
March 2018: Clinical and Applied Thrombosis/hemostasis
Adem I Diken, Adnan Yalçınkaya, Muhammet O Hanedan, Mehmet E Erol, Özlem Ercen Diken
Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin)...
February 2018: Phlebology
Alok A Khorana, Pieter W Kamphuisen, Guy Meyer, Rupert Bauersachs, Mette S Janas, Mikala F Jarner, Agnes Y Y Lee
Purpose Circulating tissue factor (TF) has been studied as a biomarker for predicting initial, but not recurrent, venous thromboembolism (VTE) in cancer, a setting in which predictors are incompletely understood. We evaluated the association of TF, clinical risk factors, and other biomarkers measured at the time of initial VTE with recurrent VTE in a prespecified analysis of the CATCH (Comparison of Acute Treatments in Cancer Hemostasis) trial. Methods CATCH was a randomized, multicenter trial that investigated tinzaparin 175 IU/kg once daily or dose-adjusted warfarin for 6 months in patients with cancer and acute, symptomatic VTE...
April 1, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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