Safety profile of tinzaparin administered once daily at a standard curative dose in two hundred very elderly patients.
OBJECTIVE
Too few very elderly patients with an age-related renal impairment are included in clinical trials. We conducted a study in order to evaluate the safety profile of tinzaparin, a low molecular weight heparin (LMWH), given at a curative dose (175 IU/kg once daily) in very elderly patients treated for up to 30 days.


METHODS
An 800-bed geriatric hospital.


METHODS
A 1-year prescribing study.


METHODS
Consecutive in-patients older than age 70, whose creatinine clearance was above 20 ml/min, and requiring full anticoagulation with LMWH were included.


METHODS
Safety parameters (major bleeding/heparin-induced thrombocytopenia/death) were recorded. Plasma anti-Xa activity levels were regularly measured throughout the treatment period.


RESULTS
Two-hundred in-patients, mean age 85.2 +/- 6.9 years (70 to 102), mean creatinine clearance 51.2 +/- 22.9 ml/min, were given tinzaparin. Six patients died during the treatment period: only one could be related to the anticoagulation treatment. Three major bleeding episodes (1.5%) were reported. Antithrombotic drug interactions likely contributed to the bleeding event in two of them. Heparin-induced thrombocytopenia was confirmed in two patients (1%). No correlation was found between anti-Xa activity and creatinine clearance or age.


CONCLUSIONS
Tinzaparin can be used safely at a curative dose in very elderly patients as long as (i) the accurate bodyweight-adjusted dose is given; (ii) platelet counts and anti-Xa levels are regularly monitored and; (iii) the interaction with other antithrombotic drugs is correctly managed.
Pautas
Eric
E
Médecine Interne--Gériatrie, Hôpital Charles Foix (University Hospital of Paris), Ivry/Seine, France.
Gouin
Isabelle
I
Bellot
Oliver
O
Andreux
Jean-Paul
JP
Siguret
Virginie
V
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000032:analysis; D001281:Atrial Fibrillation / Q000188:drug therapy; D001835:Body Weight; D003401:Creatine / Q000378:metabolism; D004347:Drug Interactions; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010976:Platelet Count; D051437:Renal Insufficiency; D000078222:Tinzaparin; D020246:Venous Thrombosis / Q000188:drug therapy
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D000990:Antithrombin III; D003401:Creatine