What adjustment is advised for enoxaparin when CrCl is less than 30 mL/min?

• A. Reduce dose
• B. Avoid
• C. Increase dose
• D. No adjustment

Answer: (A)

Renal clearance affects the dosing of enoxaparin because it is eliminated mainly by the kidneys. When CrCl falls below 30 mL/min, the drug can accumulate in the body, leading to higher anticoagulant effects and an increased risk of bleeding. To prevent this accumulation while still providing anticoagulation, the dose should be reduced. Increasing the dose would worsen accumulation and bleeding risk, while not adjusting or avoiding altogether would either ignore the pharmacokinetic change or be a more conservative approach than the test item requires. In practice, clinicians may also consider alternatives like unfractionated heparin in severe renal impairment, but the expected adjustment for reduced renal function is to lower the enoxaparin dose.