Low-Molecular-Weight Heparin for DVT Prophylaxis in Patients with Renal Insufficiency

Treatment with low-molecular-weight heparins (LMWHs) is sometimes avoided in patients with renal insufficiency because of risk for drug accumulation and bleeding, although prescribing information for enoxaparin (Lovenox) provides a reduced-dose schedule for patients with severe renal impairment. In this multicenter Canadian study partially funded by industry, 138 critically ill patients with severe renal insufficiency (mean creatinine clearance, 19 mL/minute) received dalteparin (Fragmin; 5000 IU, once daily) for deep venous thrombosis (DVT) prophylaxis. Trough levels were monitored twice weekly by measuring factor Xa inhibition (anti-Xa levels; patients with normal renal function have trough levels of ≤0.20 IU/mL; levels >0.40 IU/mL are as…