We have read with particular interest the recent article by Schmid and colleagues [1] on the use and safety of low-molecular-weight heparins (LMWH) in patients with renal insufficiency (RI). As the authors pointed out, the risk of haemorrhagic events is increased in subjects with impaired renal function, independently of the type of anticoagulant used. Low-molecular-weight heparins have been shown to cause fewer bleeding complications than unfractionated heparin (UFH) in most animal and clinical studies, although this benefit is less clear in the presence of a decreased glomerular filtration rate (GFR) [1,2]. Parallel to its growing clinical use there has been an increased incidence of major bleeding episodes during LMWH administration in recent years, mainly at the injection or instrumentation sites (including abdominal wall or epidural haematomas) [3].
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