Lim and associates160 compared the risk of major bleeding and anti-Xa levels in patients receiving LMWH who had severe renal insuf- ciency (CrCl30 mL/min) with those in patients without renal impairment (CrCl . 30 mL/min). In 12 studies involving 4,971 patients given LMWH, the OR for major bleeding was 2.25 (95% CI, 1.19-4.27) in patients with a CrCl  30 mL/min compared with that in those with a CrCl . 30 mL/min. Enox- aparin at a therapeutic dose was associated with a further increase in major bleeding in patients 95% CI, 1.78-8.45), but this was not observed when enoxaparin was empirically dose reduced (0.9% these data, nondialysis-dependent patients with CrCl30 mL/min who are treated with standard ther- apeutic doses of enoxaparin have an increased risk of major bleeding, and empirical dose reduction appears to reduce this risk. No conclusions could be made regarding other LMWHs because of limited data. 