Thus, after multiple prophy- lactic doses of enoxaparin, anti-Xa clearance was reduced by 39% and drug exposure (area under the curve of anti-Xa activity vs time) was 35% higher in patients with a CrCl,30 mL/min compared with that in patients with a CrCl  30 mL/min.156 The data on accumulation with LMWHs other than enoxaparin is limited. Although the amount of pub- lished evidence is limited, bioaccumulation of dalteparin has been reported in patients with signi - cant renal insuf ciency who receive therapeutic doses of dalteparin.157 When used in full therapeutic doses, nadroparin clearance, but not tinzaparin clearance, was shown to be correlated with CrCl (R5 0.49, P , .002),158 even when the CrCl was as Table 6 LMWH Target Ranges for the Treatment of VTE LMWH and Frequency of Administration Target Rangea (Anti-Xa units/mL) Twice daily enoxaparin 0.6-1.0 Twice daily nadroparin 0.6-1.0 Once daily dalteparin 1.05 Once daily enoxaparin .1.0 Once daily nadroparin 1.3 Once daily tinzaparin 0.85 See Table 4 legend for expansion of abbreviation. aMeasured 4 h after LMWH administration. 2012 American College of Chest Physicians by Kimberly Henricks on February 10, 2012 chestjournal.chestpubs.org Downloaded from e32S Parenteral Anticoagulants bleeding associated with the use of LMWH. 