Three groups of patients are at especially high risk of bleeding from excessive anticoagulation with renally-excreted medications: women, the elderly, and patients with chronic renal insufficiency. For all of these patients, ALWAYS dose their renally-cleared medications based on creatinine clearance, NOT just the creatinine.
Which medications in ACS does this apply to?--enoxaparin and G2B3A inhibitors are the most prominent here to consider.
The literature not only demonstrates increased bleeding complications but also increased MORTALITY if you don't dose based on creatinine clearance!
