Evidence map›Paper›PMID 23927414›Full record

ReviewExperimental hematology & oncology2013

Tinzaparin and other low-molecular-weight heparins: what is the evidence for differential dependence on renal clearance?

Kristian B Johansen, Torben Balchen

Registry-linked trialOpen access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Experimental hematology & oncology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02719418 (Study of the Bioaccumulation of Tinzaparin in Renally Impaired Patients When Given at Prophylactic Doses), which is not on this map. Cited by 25 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02719418 completednot on this mapstarted 2016, after this paper: background citation

Study of the Bioaccumulation of Tinzaparin in Renally Impaired Patients When Given at Prophylactic Doses

TypeobservationalSponsorMaisonneuve-Rosemont HospitalRan2016 to 2018Enrolled28ConditionsRenal Insufficiency, Chronic, Deep Venous Thrombosis, Protection AgainstArmsTinzaparin
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Review
  6. Review
  7. Review
  8. Review
  9. Weight-adjusted dosing of tinzaparin for thromboprophylaxis in obese medical patients.Research and practice in thrombosis and haemostasis · 2023
    Article
  10. Article
  11. Review
  12. Article
  13. Article
  14. Observational
  15. Article
  16. Review
  17. Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2020
    Review
  18. Article
  19. Anticoagulation in CKD and ESRD.Journal of nephrology · 2019
    Review
  20. The Role of Tinzaparin in Oncology.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis · 2018
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors at 2 institutions in 1 country.

Kristian B JohansenScientific Advisor, Sjoelundsparken 41, DK-3150, Hellebaek, Denmark.
Torben BalchenDanTrials ApS, c/o Bispebjerg Hospital, Copenhagen, Denmark.
Bispebjerg Hospital · DKHolbæk Sygehus · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Since low-molecular-weight heparins (LMWHs) are eliminated preferentially via the kidneys, the potential for accumulation of these agents (and an increased risk of bleeding) is of particular concern in populations with a high prevalence of renal impairment, such as the elderly and patients with cancer. The risk of clinically relevant accumulation of anticoagulant activity as a result of a reduction in renal elimination appears to differ between LMWHs. This review describes the elimination pathways for LMWHs and assesses whether the relative balance between renal and non-renal (cellular) clearance may provide a mechanistic explanation for the differences in accumulation that have been observed between LMWHs in patients with impaired renal function. Clearance studies in animals, cellular binding studies and clinical studies all indicate that the balance between renal and non-renal clearance is dependent on the molecular weight (MW): the higher the MW of the LMWH, the more the balance is shifted towards non-renal clearance. Animal studies have also provided insights into the balance between renal and non-renal clearance by examining the effect of selective blocking of one of the elimination pathways, and it is most likely that cellular clearance is increased to compensate for decreased renal function. Tinzaparin (6,500 Da) has the highest average MW of the marketed LMWHs, and there is both clinical and preclinical evidence for significant non-renal elimination of tinzaparin, making it less likely that tinzaparin accumulates in patients with renal impairment compared with LMWHs with a lower MW distribution. On the basis of our findings, LMWHs that are less dependent on renal clearance may be preferred in patient populations with a high prevalence of renal insufficiency.

Indexed as

ClearanceClinicalEliminationLow-molecular-weight heparin (LMWH)Non-clinicalPharmacodynamicsPharmacokineticsRenal insufficiencyTinzaparin

Identifiers

PMID23927414
PMCPMC3750714
OpenAlexW2120801383

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.