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Licensed indications –alternative products to tinzaparin (Katherine Le Bosquet MI Guy’s and St Thomas’ NHS Foundation Trust Alternative heparin products and fondaparinux (licensed indications only) licensed indications: Low molecular weight heparins (LMWH) Tinzaparin Dalteparin Enoxaparin Sodium sodium sodium (Innohep®) (Fragmin®) (Clexane®) Unfractionated heparin (UFH) Non-proprietary (please see note below) Fondaparinux (Arixtra®) Prophylaxis of thromboembolic disorders of venous origin, in particular those which may be associated with orthopaedic or general surgery The treatment of venous thromboembolic disease presenting with deep vein thrombosis, pulmonary embolism or both The prevention of thrombus formation in the extracorporeal circulation during haemodialysis The treatment of unstable angina and non-ST-segment-elevation myocardial infarction Prophylaxis of venous thromboembolism in medical patients bedridden due to acute illness Prophylaxis against DVT and thrombo-embolic events in susceptible patients including prophylaxis for surgical patients monitoring not required Treatment of thromboembolism (including deep vein thrombosis and pulmonary embolism) and unstable angina - continuous IV infusion (requires monitoring; in practice LMWH is used in preference) Treatment of thromboembolism (including deep vein thrombosis and pulmonary embolism) and unstable angina - continuous IV infusion (requires monitoring; in practice LMWH is used in preference) Prophylaxis against DVT and thrombo-embolic events in susceptible patients [although not specified this would include prophylaxis for surgical patients and medical patients] – monitoring not required [The information in this table has been taken from edition 62 of the BNF (September 2011) and from current SPCs via www.emc.medicines.org.uk (accessed 3/11/11)] Note: There are a number of different UFH products on the market; therefore the above presents a summary of the indications for the drug itself rather than for a specific preparation. In general UFH can be used for all the licensed indications of Tinzaparin; however this does not always follow current practice (see above).