Ask the Expert – November/December

Joel Schofer, MD
LCDR MC USN, Naval Hospital

“Ask The Expert” is a Common Sense feature where subject matter experts provide answers to questions provided by YPS members.  This edition features a leading authority on emergency cardiology, Dr. Amal Mattu.

Question: 

Should you use enoxaparin (Lovenox) in a patient with renal insufficiency in the setting of acute myocardial infarction (AMI) or chest pain concerning for acute coronary syndrome (ACS)?  If so, how does the dosing change?

Answer:

If patients have renal insufficiency (estimated glomerular filtration rate < 30 mL/minute), the recommended dose of enoxaparin should be reduced from 1 mg/kg BID to 1 mg/kg QD instead. However, be aware that there is actually little safety data on use of enoxaparin in patients with renal insufficiency and ACS, so many cardiologists prefer using unfractionated heparin in these patients instead. I'm not certain if there are DEFINITE guidelines/standards for this.

Amal FAAEM
Program Director, Emergency Medicine Residency
Associate Professor, Department of Emergency Medicine
University of of Medicine

If you have a question that you would like to have answered by an expert in a future issue of Common Sense, please send it to jschofer@gmail.com.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.