Mom’s kidney problem

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)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379338/

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 [29].

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.

https://academic.oup.com/ndt/article/32/12/1967/3091492

CKD patients have higher risks of bleeding

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2141.2003.04196.x

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).

action items

1. extent of her kidney damage

2. choice of her anticoagulation regimen

3. her housing situation when discharged

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