What are the risks associated with using LMWH in patients with impaired renal function?
The risk of HIT is threefold lower with LMWHs than with heparin and the risk of osteoporosis is lower with LMWH than with heparin. When given in prophylactic doses, LMWH has not been shown to increase the risk of bleeding complications, irrespective of the degree of impairment of renal function. Smaller doses of protamine sulfate can be given if the time since LMWH administration is longer than 8 hours and in the case of enoxaparin, dose reduction may be used in patients with CrCl,30 mL/min.