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VTE Prophylaxis Working Group
Introduction v_01
Prevention of Venous Thromboembolism (VTE) in
Hospitalized Medical and Surgical Patients
Purpose
The Tinzaparin Prophylaxis Working Group and the development of tinzaparin VTE standing
orders and other material found in this package was put together in response to the need
expressed by clinical pharmacists as they meet the ROP requirements put forth by Accreditation
Canada for VTE prophylaxis using the low molecular weight heparin (LMWH) tinzaparin.
Overview
VTE is a serious and common complication for patients in hospital or undergoing surgery.
Evidence shows that the incidence of VTE can be substantially reduced or prevented by
providing appropriate, evidence-based thromboprophylaxis interventions, In Canada, we
currently use the American College of Chest Physicians Evidence-Based Clinical Practice
Guidelines (8th edition) as the accepted standard of practice for the prevention of VTE. While
these guidelines are comprehensive they do not address specific patient needs/issues for every
individual anticoagulant therapy, rather LMWHs are discussed as a class.
Specifically the standing order, audit, education and implementation material developed by the
Tinzaparin Prophylaxis Working Group was developed to address specific questions regarding
the use of tinzaparin for VTE prophylaxis. These questions include appropriate use of
thromboprophylaxis, weight-based vs. fixed dosing, appropriate dosing for under- and overweight patients, and dosing in patients with renal impairment or on hemodialysis. In making
our recommendations we reviewed the available literature and consulted with Canadian
experts who have a significant amount of experience with LMWH and tinzaparin in particular.
Members of the Tinzaparin Prophylaxis Working Group
Reginald E. Smith, PharmD, ACPR, (Chair) Clinical Pharmacy Specialist, Royal Jubilee Hospital
Victoria, BC
William Geerts, MD, FRCPC, FCCP, Thromboembolism Specialist, Sunnybrook Health Sciences
Centre; Professor of Medicine, University of Toronto, Toronto, ON
Artemis Diamantouros, BScPharm, National Coordinator, VTE Prevention, KT Pharmacist,
Sunnybrook Health Sciences Centre, Toronto, ON
Glenn Whiteway, PharmD, Pharmacy Clinical Manager, Dr. Everett Chalmers Regional Hospital
ICU Pharmacist /Horizon Health Network; Adjunct Professor, Dalhousie School of Pharmacy,
Fredericton, NB
Mary Pederson, BScPharm, Clinical Practise Leader, Chinook Regional Hospital, Alberta Health
Services Southwest, Lethbridge, AB
VTE Prophylaxis Working Group
Introduction v_01
Patrick Robertson, BSP, PharmD, Manager, Department of Pharmaceutical Services, Saskatoon
Health Region, Saskatoon, SK
William Semchuk, MSc, PharmD, FCSHP, Manager, Clinical Pharmacy Services Regina
Qu'Appelle Health Region, Regina General Hospital, Regina, SK
Ritesh Mistry, MD, CCFP, Hospitalist, William Osler Health System, Brampton, ON; Clinical
Assistant Professor, DeGroote School of Medicine, McMaster University, Hamilton, ON
References:
Accreditation Canada, Required Organizational Practices, April 2010.
Barrett JS, Gibiansky E, Hull RD, Planes A, Pentikis H, Hainer JW et al. Population pharmacodynamics
in patients receiving tinzaparin for the prevention and treatment of deep vein thrombosis. Int J Clin
Pharmacol Ther 2001;39:431-46.
Bergqvist D, Flordal PA, Friberg B, et al. Thromboprophylaxis with a low molecular weight heparin
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molecular weight heparins: prospective observational study in medical inpatients. Drug Saf
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Hainer JW, Sherrard DJ, Swan SK, Barrett JS, Assaid CA, Fossler MJ et al. Intravenous and
subcutaneous weight-based dosing of the low molecular weight heparin tinzaparin (Innohep) in endstage renal disease patients undergoing chronic hemodialysis. Am J Kidney Dis 2002;40:531-8. Had
patients between 101-165 kg but used weight based dosing. Noted that weight-adjusted dosing
yields predictable response regardless of body weight or BMI.
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VTE Prophylaxis Working Group
Introduction v_01
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Nutescu EA, Shapiro NL, Feinstein H, Rivers CW. Tinzaparin: considerations for use in clinical
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Nutescu EA, Spinler SA, Wittkowsky A, Dager WE. Low-molecular-weight heparins in renal
impairment and obesity: available evidence and clinical practice recommendations across medical
and surgical settings. Ann Pharmacother 2009;43:1064-83.
Pahatouridis D, Alexiou GA, Zigouris A, et al. Coagulopathy in moderate head injury. The role of early
administration of low molecular weight heparin. Brain Inj. 2010;24(10):1189-92.
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at a standard curative dose in two hundred very elderly patients. Drug Saf 2002;25:725-33.
Planes A, Samama MM, Lensing AW, Buller HR, Barre J, Vochelle N et al. Prevention of deep vein
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Abstract no. 3136