Continuing Education Article Dosing Low Molecular Weight Heparins in Kidney Disease

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 adjust-ments 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.