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I read with interest the article by Koo et al¹ investigating the effect of excessive anticoagulation in patients with major bleeding. In my opinion this report contains some questionable points. The authors used various definitions of excessive anticoagulation, one of which was "full, weight-based dosing of LMWH [low-molecular-weight heparin] in the presence of renal insufficiency (serum creatinine level >1.5 mg/dL [>132.6 µmol/L])." They found 8 patients receiving LMWH despite renal insufficiency in the subset with excessive anticoagulation, although how many of them had a major bleeding event was not mentioned. Renal impairment is a known risk factor for bleeding in patients receiving LMWH because renal function plays an important role in the clearance of LMWH. Therefore, enoxaparin is excreted renally, and a linear correlation has been established between creatinine clearance (CLCr) and anti-Xa activity, a measure of enoxaparin activity.^2-3 Patients with a CLCr less than 30 mL/min (<0.5 mL/s) demonstrated . . . [Full Text of this Article]

AUTHOR INFORMATION
Enrique Antón, MD, PhD

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