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What are the dosing recommendations for enoxaparin and other low molecular weight heparin in CKD?
Enoxaparin dose should be adjusted for the treatment of the most common thrombotic disorders in patient with CKD. For patients with stable estimated GFR less than 30 mL/min, the dose should be adjusted to 1 mg/kg per day and Xa activities should be monitored twice a week initially, then weekly after 2 weeks of treatment.
The heparin level should be drawn 4 hours after the dose and the dose should be adjusted to heparin level of 0.7 to 1.1. Unfractionated heparin should be considered the alternative of choice for patients with unstable kidney function or undergoing dialysis.
Dosage Recommendations for Anticoagulations in Chronic Kidney Disease
| DRUGS | NORMAL DOSAGE | CKD STAGE 3-5 | HD |
|---|---|---|---|
| Alteplase | 60 mg over 1 h, then 20 mg/h for 2 h | 100% | 100% |
| Anistreplase | 30 U over 2–5 min | 100% | 100% |
| Apixaban | 5 mg po bid | 100% | 50% |
| Aspirin | 81–325 mg/day | 100% | 100% |
| Clopidogrel | 75 mg/day | 100% | 100% |
| Dabigatran | 150 mg po bid | 100% | AVOID |
| Dalteparin | 100 U/kg | 100% | Avoid Check anti–factor Xa activity 4 h after second dose in patients with kidney dysfunction |
| Dipyridamole | 50 mg tid | 100% | 100% |
| Enoxaparin | 1 mg/kg q12h | 100% | 50% |
| Fondaparinux | 2.5–10 mg Subq | 100% | Avoid |
| Heparin | 75 U/kg load then 15 U/kg/h | 100% | 100% |
| Iloprost | 0.5–2.0 ng/kg/min for 5–12 h | 100% | 100% |
| Prasugrel | 10 mg | 100% | 100% |
| Rivaroxaban | 20 mg/day | 50%–75% | Avoid |
| Streptokinase | 250,000-U load, then 100,000 U/h | 100% | 100% |
| Sulfinpyrazone | 200 mg bid | 100% | 100% |
| Ticlopidine | 250 mg bid | 100% | 100% |
| Tinzaparin | 175 U/kg | 100% | Avoid |
| Tranexamic acid | 25 mg/kg tid–qid | 50% | 25% |
| Urokinase | 4,400-U/kg load, then 4,400 U/kg qh | 100% | 100% |
| Warfarin | 5 mg per day then adjust per INR | 100% | 50%–100% |
CKD, Chronic kidney disease; HD, hemodialysis; INR, international normalized ratio; U, units.
