A 75-year-old client weighing 60 kg has been on therapeutic … | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A 75-year-old client weighing 60 kg has been on therapeutic enoxaparin 1 mg/kg subcutaneously every 12 hours for a recent DVT for 4 days. The peak anti-Xa level (drawn 4 hours after the morning dose) is 1.4 IU/mL; institutional therapeutic peak target for q12h dosing is 0.5-1.0 IU/mL. Creatinine clearance is 35 mL/min. Which action by the nurse is most appropriate?
1Increase the dose to 1.5 mg/kg every 12 hours to reach optimal coagulation.
2Hold the next dose and notify the provider; an anti-Xa of 1.4 IU/mL with the patients age (≥75), weight ≤60 kg, and CrCl ✓ Correct answer
3Continue the current dose because anti-Xa above range simply means more clot prevention.
4Switch to UFH bolus immediately to overcome the LMWH effect.
Explanation
Anti-Xa interpretation — supratherapeutic LMWH Anti-Xa level monitoring is recommended for LMWH in patients with renal impairment, obesity, pregnancy, extremes of age, or unexpected bleeding/clotting. Therapeutic peak (drawn 4 hours after SC dose): • Treatment q12h dosing: 0.5-1.0 IU/mL. • Treatment q24h dosing: 1.0-2.0 IU/mL. • Prophylaxis: 0.2-0.5 IU/mL.
This client has 1.4 IU/mL at q12h dosing — supratherapeutic. Risk factors for accumulation are present (age ≥75, weight ≤60 kg, CrCl
In-depth explanation
Clinical reasoning summary Anti-Xa interpretation — supratherapeutic LMWH Anti-Xa level monitoring is recommended for LMWH in patients with renal impairment, obesity, pregnancy, extremes of age, or unexpected bleeding/clotting. Therapeutic peak (drawn 4 hours after SC dose): • Treatment q12h dosing: 0.5-1.0 IU/mL. • Treatment q24h dosing: 1.0-2.0 IU/mL. • Prophylaxis: 0.2-0.5 IU/mL.
This client has 1.4 IU/mL at q12h dosing — supratherapeutic. Risk factors for accumulation are present (age ≥75, weight ≤60 kg, CrCl