Which medication is contraindicated for VTE prophylaxis in patients with CrCl less than 30 mL/min?

Rivaroxaban is a direct oral anticoagulant that specifically requires dose adjustment based on renal function. In patients with a creatinine clearance (CrCl) less than 30 mL/min, the use of rivaroxaban is contraindicated due to concerns about an increased risk of bleeding and insufficient efficacy, as the drug relies upon renal clearance for its effects.

This reflects an understanding of pharmacokinetics and safety considerations in patients with impaired renal function, as their ability to metabolize and eliminate certain medications may be significantly compromised.

In contrast, enoxaparin is still considered safe for use in patients with CrCl below 30 mL/min, though it may also require dose adjustments based on the degree of renal impairment. Apixaban has a safer profile for lower CrCl levels compared to rivaroxaban, and while it may require caution and possible dose adjustments in similar patients, its use is not strictly contraindicated until CrCl falls below 15 mL/min. Levonorgestrel, being a contraceptive, does not play a role in VTE prophylaxis and therefore is unrelated to concerns about renal function in this context.