Impact of Assessing Customized Enoxaparin Regimens for DVT Prevention in CKD Patients - A Prospective Review

Chronic kidney disease (CKD) is associated with profound disturbances in haemostasis that create a paradoxical clinical state characterized by an increased risk of venous thromboembolism alongside an inherent tendency toward bleeding. Alterations in platelet function, endothelial integrity, and coagulation factor activity contribute to a prothrombotic milieu, explaining the higher incidence of deep vein thrombosis observed across all stages of CKD, particularly in advanced disease. To evaluate Enoxaparin, a low-molecular-weight heparin commonly used for thromboprophylaxis, offers advantages such as predictable anticoagulant response and ease of administration; however, it challenges by predominant renal elimination raises concerns regarding drug accumulation and bleeding complications in patients with reduced kidney function. Evidence indicates that standard fixed-dose enoxaparin regimens may result in variable and frequently elevated anti-factor Xa levels in moderate to severe CKD, while unstructured dose reduction can compromise antithrombotic efficacy. In response to these challenges, customized enoxaparin regimens incorporating renal function–based dose adjustment and selective anti-Xa monitoring have been proposed to optimize the balance between safety and efficacy. Such individualized strategies appear to provide more consistent anticoagulant exposure and reduce bleeding risk without diminishing prophylactic effectiveness, particularly in patients with advanced CKD, underscoring the importance of tailored anticoagulation approaches rather than uniform dosing in this high-risk population.