Dosing considerations and monitoring of low molecular weight heparins and glycoprotein IIb/IIIa antagonists in patients with renal insufficiency.

Glycoprotein IIb/IIIa inhibitors and low molecular heparins are important new components of the medical treatment for acute coronary syndromes (ACS). Renal insufficiency is a common comorbid condition and high-risk marker for ACS. The safety and efficacy of these treatments in ACS are dependent on the pharmacokinetics of the specific medication. Even though these treatments have been studied in large randomized controlled trials in ACS, there are few prospective data regarding their safety or efficacy in renal insufficiency. Most have been shown to be safe and effective in mild to moderate degrees of renal insufficiency; none have been thoroughly studied in severe renal disease or in patients requiring dialysis therapy. Future prospective trials should include patients with more severe renal insufficiency, as well as combinations of the current recommended therapies.