Which of the following medications is contraindicated in a patient with a creatinine clearance of less than 30 mL/minute undergoing PCI?

Fondaparinux is contraindicated in patients with a creatinine clearance of less than 30 mL/minute, particularly in the context of undergoing percutaneous coronary intervention (PCI). The reason for this contraindication stems from the drug's renal excretion pathway. Fondaparinux is primarily eliminated by the kidneys, and impaired renal function can lead to an accumulation of the drug, increasing the risk of bleeding without providing therapeutic benefit. Thus, when the creatinine clearance is below this threshold, there is an unacceptable safety risk associated with its use.

In contrast, enoxaparin, intravenous heparin, and bivalirudin have different dosing considerations or less stringent contraindications regarding renal function. While enoxaparin may require dose adjustments in patients with compromised renal function, it is not completely contraindicated. Intravenous heparin does not have a specific contraindication based on renal function, and bivalirudin is also considered safe to use, even in those with renal impairment, provided adequate monitoring and dose adjustments are made. Understanding the renal clearance of anticoagulant medications is crucial when evaluating their safety in patients with reduced kidney function, particularly in high-risk settings like PCI.