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We read with interest the recent report by Nagge and colleagues¹ titled "Is Impaired Renal Function a Contraindication to the Use of Low-Molecular-Weight Heparin?" in the December 2002 issue of the ARCHIVES. We have used dalteparin as our anticoagulant of choice for critically ill patients requiring continuous venovenous hemofiltration for the last year (all with creatinine clearance <30 mL/min). Due to lack of available dosing data and potential benefits of dalteparin, we recently reported our experience in 52 consecutive patients to the Intensive Care Society of Great Britain (abstract to be published in the British Journal of Anaesthesia). This is, to our knowledge, the largest series in which fractionated heparin has been used in critically ill patients.

We have been using a dalteparin regimen comprising a bolus dose of 30 to 40 IU/kg followed by an infusion of 15 to 20 IU/kg per hour and found a bleeding complication . . . [Full Text of this Article]

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