enoxaparin can damage kidney and CrCl
Over-anticoagulation can occur in patients with moderate (CrCl 30–50 mL/min) to severe renal dysfunction (CrCl <30 mL/min)
Thus, an LMWH with a lower molecular weight are is more dependent on renal clearance and therefore may accumulate in patients with renal dysfunction and may be more pronounced with the smaller LMWH .
reduce to 1mg/kg once a day if eGFR < 30mL/min . now she gets 1.5 mg twice a day. 3x of the recommended dose if her CrCl is low.
Cockcroft and Gault equation should be used for low therapeutic index and high-risk drugs. In other cases, eGFR is an adequate estimate of the CrCl.
CKD patients have higher risks of bleeding
Differences between LMWH.
Enoxaparin has 4300 dalton and tin ape run has 5800.
Use of low doses of low‐molecular‐weight heparin (< 3500 anti‐FXa units/d) is associated with equal efficacy and better safety compared with low‐dose unfractionated heparin, whereas use of higher doses of low‐molecular‐weight heparin is associated with significantly greater bleeding (Koch et al, 2001; Mismetti et al, 2001).
1. extent of her kidney damage
2. choice of her anticoagulation regimen
3. her housing situation when discharged