For dose adjustments in adult patients with <50kg or >120kg, refer to the GGC guideline Heparin Dose Adjustment in Adult Patients with Very High or Low Body Weight here.
| LMWH |
Creatinine Clearance* (CrCl) |
||
| ≥30ml/minute | 15-29ml/minute | <15ml/minute | |
| Enoxaparin | 40mg once daily | 20mg once daily | 20mg once daily (off label)** |
| Dalteparin | 5000units once daily | 5000units once daily | 2500units once daily |
*GGC CrCl calculator available within the GGC Medicines App, or to manually calculate the CrCl - see here.
**Reflects national practice by renal teams, expert opinion and historical experience. In most patients with severe renal impariment, prophylactic dose of enoxaparin does not appear to be associated with an increased bleeding risk and can be used without the need for anti-Xa monitoring. See the full GGC guideline Heparin Dose Adjustment in the Presence of Renal Impairment for further information.
The table below relates to treatment doses for VTE (venous thromboembolism).
For dose adjustments in adult patients with <34kg or >120kg, refer to the GGC guideline Heparin Dose Adjustment in Adult Patients with Very High or Low Body Weight here.
| LMWH |
Creatinine Clearance* (CrCl) |
||
| ≥30ml/minute | 15-29ml/minute | <15ml/minute | |
|
Enoxaparin (weight-banded dosing)** |
1.5mg/kg once daily Consider enoxaparin 1mg/kg twice daily in patients with high bleeding risk or patients perceived to be at high risk of recurrent VTE |
1mg/kg once daily. Remains treatment of choice if CrCl<15ml/min |
There is a limited evidence base for treatment LMWH in severe renal impairment and a significantly increased bleeding risk. Use unfractionated heparin (UFH) where suitable. If UFH unsuitable use enoxaparin 1mg/kg OD (off-label, max 120mg). NB: associated with a significant increased bleeding risk, ensure anti-Xa monitoring in place.*** |
|
Dalteparin (weight-banded dosing) |
200units/kg once daily [max 18,000 units] Consider dalteparin 100units/kg twice daily in patients with high bleeding risk. |
200units/kg once daily [max 18,000 units] Consider dalteparin 100units/kg twice daily in patients with high bleeding risk |
|
*GGC CrCl calculator available within the GGC Medicines App, or to manually calculate the CrCl - see here.
**For guidance on weight-banded dosing of enoxaparin, see here.
***Monitoring: if CrCl<30ml/min consider assessing anti-Xa activity after 3rd dose (to confirm therapeutic levels have been achieved) and after 8-10th dose to ensure there has been no significant drug accumulation (target 4h peak level: 0.5-1.2units/ml). See the full GGC guideline Heparin Dose Adjustment in the Presence of Renal Impairment for further information.
History of heparin allergy or heparin-induced thrombocytopenia (HIT), applies to UFH and LMWH.
Guideline reviewed: August 2025
Page updated: July 2026
