A 74-year-old man has an eGFR of 20 mL/min and is prescribed enoxaparin 40 mg daily for VTE prophylaxis. What should the prescriber do?
Answer and explanation
Correct answer: C. Reduce the dose or use unfractionated heparin
- Step 1: Enoxaparin is renally cleared.
- Step 2: Severe renal impairment (creatinine clearance under 30 mL/min) needs dose reduction or unfractionated heparin.
Answer
Reduce the dose or use unfractionated heparin.
Why not the others: Increase to 80 mg daily: Increasing worsens bleeding risk. Stop all prophylaxis for the whole of the admission: Stopping without reason leaves him at risk of VTE. Continue the standard dose: Accumulation risks major bleeding.
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