We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Additional Considerations to Precede Selection of Enoxaparin Therapy

Marta A. Miyares, PharmD, BCPS (AQ Cardiology)
JAMA Intern Med. 2013;173(11):1036-1037. doi:10.1001/jamainternmed.2013.421.
Text Size: A A A
Published online


DeCarolis and colleagues1 are to be commended for their review of patients receiving an unadjusted dosage of enoxaparin sodium regardless of normal or moderate renal function and consequent bleeding episodes, demonstrating major bleeding in 5.7% of those with normal renal function compared with 22% of those with moderate renal function.

While the authors of this study and the corresponding Invited Commentary2 appropriately accentuate the need for revised recommendations that use lower doses or percentage dosage adjustments, there are certain features in this investigation that merit accentuation and additional explanation. First, the authors report that among those with active cancer, 18.1% of those with normal renal function and 13.6% of those with moderate renal function were transitioned to therapy with warfarin sodium. According to the CLOT (Randomized Comparison of Low-Molecular-Weight Heparin vs Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer) trial,3 dalteparin, a low-molecular-weight heparin, was more effective than warfarin in reducing the risk of recurrent thromboembolism without increasing bleeding risk. Activated factor X was measured in patients who developed clinically significant renal dysfunction. Therefore, it should be highlighted that patients with active cancer should not have been transitioned to warfarin therapy. In addition, as reports have demonstrated that dalteparin may have less bioaccumulation compared with enoxaparin, dalteparin may be a better option in patients with cancer with moderate renal impairment. Nevertheless, renal dosing recommendations for this low-molecular-weight heparin are also lacking.



Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





June 10, 2013
Douglas D. DeCarolis, PharmD; Gerhard J. Johnson, MD
JAMA Intern Med. 2013;173(11):1036-1037. doi:10.1001/jamainternmed.2013.1050.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles