innohep – tinzaparin sodium

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innohep®

tinzaparin sodium

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“A baby is something you carry inside you for nine months, in your arms for three years, and in your heart until the day you die.”

– Mary Mason –

Antenatal assessment and management (to be assessed at booking and repeated if admitted)

Any previous VTE except a Single event related to major surgery

                <p style="text-align: center;"><strong>HIGH RISK</strong></p><p style="text-align: center;"><strong>Requires antenatal prophylaxis with LMWH</strong>refer to trust-nominated thrombosis in pregnancy expert/team

Hospital admission

Single previous VTE related to major surgery

High-risk thrombophilia + no VTE

Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU

Any surgical procedure e.g. appendicectomy

OHSS(first trimester only)

INTERMEDIATE RISK

Consider antenatal prophylaxis with LMWH

Obesity (BMI > 30KG/M²)AgeParity ≥ 3SmokerGross varicose veinsCurrent pre-eclampsiaImmobility, e.g. paraplegia, PGPFamily history of unprovoked or estrogen-provoked VTE in first-degree relativeLow-risk thrombophiliaMultiple pregnancyIVF/ART

Transient risk factors:

Dehydration/hyperemesis; current systemic infection; long-distance travel

Fewer than three risk factors

Four or more risk factors:Prophylaxis from first trimesterThree risk factors:Prophylaxis from 28 weeks

LOWER RISK

Mobilisation and avoidance of dehydration

For more information

Regarding the timing of first antenatal and/or postnatal thromboprophylactic dose; please refer to RCOG Green-Top Guideline No. 37a (thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the risk – Published 13/04/2015)

Postnatal assessment and management (to be assessed on delivery suite)

Any previous VTEanyone requiring antenatal LMWHHigh-risk thrombophiliaLow-risk thrombophilia + FHx

HIGH RISK

At least 6 weeks, postnatal prophylactic LMWH

caesarean section in labour

BMI ≥ KG/M²

Readmission or prolonged admission (≥3 days) in the puerperium

Any surgical procedure int the puerperium except immediate repair of the perineum

Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU

INTERMEDIATE RISK

At least 10 days postnatal prophylaxis with LMWH

NB if presisting > 3 risk factors; consider extending thromboprophylaxis with LMWH

Age > 35 yearsObesity (BMI > 30KG/M²)Parity ≥ 3SmokerElective caesarean sectionFamily history of VTELow-risk thrombophiliaGross varicose veinsCurrent systemic infectionCurrent pre-eclampsiaImmobility, e.g. paraplegia, PGP, long-distance travelMultiple pregnancyPreterm delivery in this pregnancy (<37+0 weeks)Stillbirth in this pregnancyMid-cavity rotational or operative deliveryProlonged labour (< 24 hours)PPH > 1 litre or blood transfusionFamily history of unprovoked or estrogen-provoked VTE in first-degree relativeLow-risk thrombophiliaMultiple pregnancyIVF/ARTTwo or more risk factorsFewer than two risk factors

LOWER RISK

Mobilisation and avoidance of dehydration

Antenatal and post natal prophylactic dose of LMWH

Weight < 50KG = 20MG enoxaparin / 2500UNITS dalteparin / 3500UNITS tinzaparin daily.Weight 50-90KG = 40MG enoxaparin / 5000UNITS dalteparin / 4500UNITS tinzaparin daily.Weight 91-130KG = 60MG enoxaparin / 7500UNITS dalteparin / 7000UNITS tinzaparin daily.Weight 131-170KG = 80MG enoxaparin / 10000UNITS dalteparin / 9000UNITS tinzaparin daily.Weight > 170KG = 0.6MG/KG enoxaparin / 75UNITS/KG dalteparin / 75UNITS/KG tinzaparin daily.