Sule Ashish Anil, Tay Jam Chin, Arul Earnest
Department of General Medicine;
Int J Angiol. 2009 Winter;18(4):184-6. doi: 10.1055/s-0031-1278351.
To assess whether there was an increased risk of bleeding with enoxaparin in patients with a creatinine clearance (CCT) of less than 30 mL/min.
Patients with a CCT of less than 30 mL/min who were given enoxaparin 1 mg/kg/day were included. Antifactor Xa levels (peak and trough) were measured after three doses (days) of enoxaparin. The peak antifactor Xa levels were measured 4 h after the third enoxaparin dose, and the trough levels of antifactor Xa were measured 12 h and 24 h after the third enoxaparin dose. Basic demographic data such as age, sex, race, diagnosis and creatinine values were assessed at baseline. Adverse events were monitored and recorded. Domain-specific review board approval was obtained before the present study began.
A total of 15 patients were recruited for the present study. Three patients dropped out of the study; therefore, 12 patients were analyzed. The mean age of the 12 patients was 69.25 years (range 41 to 89 years). There were six men and an equal number of women. There were eight Chinese patients, three Malay patients and one Indian patient. The indication for anticoagulation was deep vein thrombosis in seven patients, non-ST elevation myocardial infarction in four patients and atrial fibrillation in one patient. There were no adverse events noted in any patient.
It is safe to administer enoxaparin once a day to patients with renal impairment and a CCT of less than 30 mL/min.
评估肌酐清除率（CCT）低于30 mL/分钟的患者使用依诺肝素后出血风险是否增加。
纳入CCT低于30 mL/分钟且接受1 mg/kg/天依诺肝素治疗的患者。在给予依诺肝素三剂（天）后测量抗Xa因子水平（峰值和谷值）。在第三次给予依诺肝素后4小时测量抗Xa因子峰值水平，在第三次给予依诺肝素后12小时和24小时测量抗Xa因子谷值水平。在基线时评估年龄、性别、种族、诊断和肌酐值等基本人口统计学数据。监测并记录不良事件。在本研究开始前获得特定领域审查委员会的批准。
本研究共招募了15名患者。3名患者退出研究；因此，对12名患者进行了分析。12名患者的平均年龄为69.25岁（范围41至89岁）。有6名男性和同等数量的女性。有8名中国患者、3名马来患者和1名印度患者。抗凝的适应证为7例深静脉血栓形成、4例非ST段抬高型心肌梗死和1例心房颤动。未在任何患者中观察到不良事件。
对于肾功能不全且CCT低于30 mL/分钟的患者，每天给予一次依诺肝素是安全的。
