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I'm rotating through a community hospital, and all the EM attendings use Lovenox in patients with chronic renal insufficiency. Who else does this???
Do you use Lovenox in patients with renal insufficiency?
- Thread starter waterski232002
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What kind of GFR do these patients have. What sort of Lovenox dosing are we talking? Prophylactic dosing or 1mg/kg BID?
Usually, you're safe to use prophylactic dosing (40 mg) until GFR drops below 30. Then you use 30 until the patient is ESRD. Then, you need to use UF heparin (5000 U q8h).
For treatment doses (PE, ACS), your dosing is 1mg/kg q12 for GFR>30 and 1mg/kg for GFR<30. Unless you have access to FactorX activity (which you wont at at community hospital), I don't think anyone uses Lovenox in ESRD.
Another thing with lovenox is the weight of the patient. Most CKDs are pretty heavy. Using Lovenox for anyone over 120 kg has never been studied. And, honestly, that's like half my patients. I'll (arbitrarily) go up to 150kg but never above that. If they are that heavy, they stay in the hospital for UF heparin bridging.
Usually, you're safe to use prophylactic dosing (40 mg) until GFR drops below 30. Then you use 30 until the patient is ESRD. Then, you need to use UF heparin (5000 U q8h).
For treatment doses (PE, ACS), your dosing is 1mg/kg q12 for GFR>30 and 1mg/kg for GFR<30. Unless you have access to FactorX activity (which you wont at at community hospital), I don't think anyone uses Lovenox in ESRD.
Another thing with lovenox is the weight of the patient. Most CKDs are pretty heavy. Using Lovenox for anyone over 120 kg has never been studied. And, honestly, that's like half my patients. I'll (arbitrarily) go up to 150kg but never above that. If they are that heavy, they stay in the hospital for UF heparin bridging.
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I was talking about treatment doses for DVT, PE, ACS, etc
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Usually, no.
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Learned any interesting tidbit from a pharmacist the other day....apparently if someone is in renal failure and has an indication for lovenox, go ahead and give it at the therapeutic dose and don't freak out over their renal failure. There's no required dose adjustment for the first dose given...should be dosed accordingly after that.
I think that with CRF/ESRD I'd still use heparin cause 1. you can turn it off, 2. you can reverse it.
If there was a heparin allergy (in theory you could try lovenox), but I'd probably go right for argatroban.
Not sure why they've gone to lovenox as first line..maybe if they were trying for outpatient treatment.
I think that with CRF/ESRD I'd still use heparin cause 1. you can turn it off, 2. you can reverse it.
If there was a heparin allergy (in theory you could try lovenox), but I'd probably go right for argatroban.
Not sure why they've gone to lovenox as first line..maybe if they were trying for outpatient treatment.
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This is true of a lot of medicines. The first dose is usually the same. With many medicines, the dose is the same and only the time interval between doses is different.
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I remember on one rotation I was lectured for about 30 min on rounds on why NEVER to give lovenox in renal insufficiency. About an hour later I was posed the question by the clerkship director...and firmly said NO..you shouldn't give it...of course his response to myself and the group was...you can DEFNINTELY give it.
AHH...the life of a med student.
AHH...the life of a med student.
