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Briefing note: tinzaparin sodium (Innohep)

What is tinzaparin used for?

Tinzaparin is used to treat venous thromboembolism (VTE). VTE includes two conditions: deep vein thrombosis (affecting lower limbs) and pulmonary embolism (affecting the lungs). VTE develops when a blood clot forms in a vein. Blood flow can be restricted around the clot and may cause pain and swelling. There is a risk that all or part of the clot breaks off and is transported through the veins to become lodged in the lungs where it forms a pulmonary embolism, which can be fatal. The risk of developing a VTE is increased
in cancer patients with solid tumours and preventative treatment should be considered.

How does it work?

Tinzaparin is a type of heparin which is an established blood thinning medicine (known as an anticoagulant) that prevents the formation of blood clots and lowers the risk of heart attack and stroke. It works by keeping the blood flowing smoothly by lowering the activity of clotting proteins in the blood. It is given by injection under the skin.

What has SMC advised?

SMC has accepted tinzaparin for use in patients with solid tumours for the extended treatment of symptomatic venous thrombo-embolism (VTE) and prevention of its recurrence.

What is the evidence to support this advice?

  • Two studies of patients with cancer and VTE, found that tinzaparin was associated with rates of VTE recurrence that were similar to those for patients treated with a vitamin K antagonist (VKA). Another larger study found that tinzaparin treatment had similar effects on the occurrence of symptomatic deep vein thrombosis (DVT), non-fatal and fatal pulmonary embolism (PE), incidental DVT and PE, to VKA treatment.
  • An economic analysis compared tinzaparin with another type of heparin. Although there were some weaknesses in the analysis overall it was found that it offered value for money.

SMC has accepted tinzaparin for use in NHSScotland because the balance of costs and benefits meant that it was considered to offer value for money. This SMC advice is dependent upon the continuing availability of the PAS or a list price that is equivalent or lower.