• for patients with eGFR less than 30ml/min who may require surgery (elective or emergency) within 24 hours, use low dose unfractionated heparin 5000 units SC twice daily - please refer to local unit policies.
  • if weight less than 50kg, consider using creatine clearance (e.g. Cockroft-Gault) instead of eGFR for estimation of renal function.
  • for patients with the combination of an extreme of body weight and renal impairment, consult with Pharmacy or Haematology

 

eGFR 10-30ml/min
  • Dalteparin 5000 units SC daily
  • Monitor LMW Heparin level after 10 days*
eGFR less than10ml/min or patients on renal replacement therapy
  • Consider mechanical measures only
  • If high thrombosis risk consider Dalteparin 2500 SC daily
  • Monitor LMW Heparin level after 10 days*

*Guidance on LMW Heparin assay for monitoring thromboprophylaxis

  • Target peak range for thromboprophylaxis is 0.1-0.4 units/ml.
  • Order as “Heparin assay” (click on LMW[1]Heparin assay) on TRAK; no need to call duty haematologist but inform haematology laboratory staff if request is urgent (ext 26093, page 6550/via switchboard out-of-hours). See p25.
  • Level must be checked 3-4 hours post dose.
  • If level is within the appropriate range no need to repeat unless any signs of bleeding or bruising.
  • For patients requiring an invasive procedure/intervention/surgery withhold SC dalteparin the evening before the procedure, and take a “trough” LMW Heparin level to ensure there is no accumulation (level should be less than 0.1 anti-Xa units/ml).