How should a dose of enoxaparin be adjusted for a patient with renal impairment?

The correct approach for adjusting the dose of enoxaparin in a patient with renal impairment is to reduce the dose based on creatinine clearance. Enoxaparin is primarily eliminated by the kidneys, so renal function significantly affects its clearance from the body. As renal function declines, the risk of accumulation of the drug increases, leading to a higher risk of bleeding and other adverse effects.

Monitoring creatinine clearance allows healthcare providers to tailor the enoxaparin dose to the patient's renal function, thereby maintaining efficacy while minimizing the risk of complications. Clinicians often refer to established dosing guidelines that provide specific dosage adjustments based on different levels of renal impairment, typically using the patient's creatinine clearance calculated from the serum creatinine level.

This careful adjustment ensures that therapeutic levels are maintained without causing toxicity, which is particularly important in anticoagulation therapy.