From the Guidelines
For a patient with an eGFR of 66 ml/min/1.73m², the recommended therapeutic dose of enoxaparin (Clexane) is 1.5 mg/kg once daily with no dose adjustment needed. This dosing is appropriate because an eGFR of 66 indicates moderate kidney function, which is above the threshold (30 ml/min/1.73m²) where dose adjustments would be required 1. When administering enoxaparin, it should be given subcutaneously, preferably at the same time each day. The patient's weight in kilograms should be used to calculate the exact dose. For example, a 70 kg patient would receive 105 mg daily.
Key Considerations
- Regular monitoring of anti-Xa levels is not routinely required at this kidney function level, but should be considered for patients who are very elderly, have fluctuating kidney function, or are at high risk of bleeding 1.
- Renal function should be reassessed periodically during treatment, as any significant decline below an eGFR of 30 would necessitate dose adjustment to prevent drug accumulation and increased bleeding risk 1.
Dosing and Administration
- The dose of enoxaparin is 1.5 mg/kg SC once daily for patients with moderate kidney function (eGFR ≥ 30 ml/min/1.73m²) 1.
- In the presence of impaired renal function (CrCl <30 mL per minute), the dose should be reduced to 1 mg/kg SC once daily, and strong consideration should be given to UFH as an alternative 1.
Monitoring and Follow-up
- Patients should be monitored for signs of bleeding, and renal function should be reassessed periodically during treatment 1.
- Anti-Xa levels should be monitored in patients with severe renal insufficiency or those at high risk of bleeding 1.
From the Research
Therapeutic Dose of Clexane (Enoxaparin) for eGFR of 66
- The therapeutic dose of Clexane (Enoxaparin) for a patient with an estimated Glomerular Filtration Rate (eGFR) of 66 is not directly stated in the provided studies.
- However, according to the study 2, a dosing strategy for patients with renal impairment receiving enoxaparin suggests that a first unadjusted dose of 1 mg/kg followed by a regimen of 0.8 mg/kg/12h in patients with moderate renal impairment (which may include an eGFR of 66) should avoid accumulation of enoxaparin and keep peak anti-Xa activities between 0.5 and 1.2 IU/mL for a large majority of patients.
- Another study 3 suggests that no dosage adjustment from the standard 1.0 mg/kg 12 hourly is required for the first 48 h of treatment, and maintenance doses thereafter can be calculated using standard proportional adjustments based on the fraction of drug excreted unchanged (Fu) equal to 0.71.
- The study 4 indicates that enoxaparin major bleeding complications at a GFR < 60 ml/min increase significantly, and despite dose adjustment, the major bleeding risk is still significantly increased in patients with a GFR < 60 ml/min versus those with a GFR > 60 ml/min.
- The study 5 suggests that enoxaparin dose reduction according to renal function decreases the risk of overdosing and potentially the risk of bleeding, but the risk of underdosing seems less predictable, and anti-Xa assay may be useful in severe clinical situations that require higher anticoagulant activity.
- For a patient with an eGFR of 66, the dose of 1.5 mg/kg may be considered, but it is essential to monitor anti-Xa levels to ensure therapeutic anticoagulation and adjust the dose accordingly, as suggested by the studies 6 and 5.