Hello, I would like to clarify my previous question. Specifically, is there a LMWH that can be used below 20 mL/min without risking saccumulation? Thank you for your attention

Hello,Thank you for taking the time to send us your question again! Indeed, the use of LMWH in renal failure is very interesting. Several hospital centers in the region have positioned themselves in this regard by modifying their use protocols to promote the use of products that do not accumulate in patients with renal insufficiency.The molecule that is coming to the fore more and more is tinzaparin (Innohep). Indeed, although it is eliminated mainly at the renal level at nearly 90%, tinzaparin does not "accumulate in CKD and can be prescribed at usual dosage, regardless of the severity of chronic kidney disease, in curative and preventive indications." (SiteGPR.com, 2016)That said, there seems to be reassuring data on the prophylactic dose of dalteparin (Fragmin). The European Journal of Clinical Pharmacology reported in 2015 that "prophylactic dosages of tinzaparin and dalteparin are likely to be safe in patients with renal insufficiency and do not need dose reduction based on the absence of accumulation." This is an interesting lead for the safety of our patients!Hopefully, I have clearly answered your question,Stéphane Villeneuve, pharmacist