title: Dosing low molecular weight heparins in kidney disease.
abstract: The low molecular weigh heparins (LMWHs) are primarily eliminated renally, and current literature indicates that there is a reduction in clearance and an increase in half-life of LMWHs in patients with severe chronic kidney disease (CKD) associated with elevated anti-Xa levels and an increased risk of bleeding. It therefore becomes clinically prudent to evaluate dosing adjustments in CKD. The American College of Chest Physicians (ACCP), in its 2008 consensus statement, recommends 5 possible approaches to dosing LMWH in patients with severe CKD. In evaluating the individual compounds, enoxaparin, dalteparin, and tinzaparin, this article attempts to address the preferred dosing strategies.
authors.affiliation: Comprehensive Pharmacy Services, Costa Mesa, CA, USA. manny.saltiel@cpspharm.com
authors.forename: Manny
authors.initials: M
authors.lastname: Saltiel
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D015951:Factor Xa / Q000032:analysis*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D015951:Factor Xa