Excessive anticoagulation in patients with mild renal insufficiency receiving long-term therapeutic enoxaparin.
Low-molecular-weight heparins, such as enoxaparin, are increasingly being used for treatment of venous thromboembolism. We describe two patients who received therapeutic enoxaparin for several months. Although their serum creatinine values were normal, both had mild renal insufficiency (creatinine clearance 60-70 ml/min), and both accumulated the drug abnormally and experienced clinical bleeding. These results suggest that patients receiving enoxaparin (or other low-molecular-weight heparins) in therapeutic doses for periods of more than 4 weeks should be considered for laboratory monitoring to avoid bleeding.
Divisions of Hematology and Oncology, Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
L T
LT
Busby
A
A
Weyman
G M
GM
Rodgers
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D003401:Creatine / Q000097:blood; D016903:Drug Monitoring; D017984:Enoxaparin / Q000009:adverse effects* / Q000493:pharmacokinetics; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D051437:Renal Insufficiency / Q000139:chemically induced*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy
D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D003401:Creatine