For the no-monitoring comparator group, we used a study that reported no anti-Xa monitoring or dose adjustments (enoxaparin, 1 mg/kg body weight, was administered subcutaneously twice a day) to determine the risk of major bleeding.96 We found no studies that reported the risk of VTE or mortality associated with no anti- Xa monitoring. Included studies grouped patients with varying indications for LMWH, most commonly patients with acute VTE, atrial fibrillation, and acute coronary syndrome. The panel agreed that studies with grouped indications would be used for the outcome of major bleeding and the evidence rated down for indirectness. Studies with grouped indications were also combined for the outcome of percentage of anti-Xa concentrations in the therapeutic range. Studies with grouped indications were not used for the outcome of PE, DVT, or mortality. Combined studies administered different LMWHs (enoxaparin and tinzaparin) and used different dosing regimens (once daily and twice daily). The EtD framework is shown in online at https://dbep.gradepro.org/profile/ 44981d40-71aa-4205-bda3-a8471c085c8b. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. After indirect comparison of the available evidence from separate studies, it appears that adjusting the LMWH dose based on monitoring anti factor Xa concentrations for patients with renal dysfunction was associated with reduced risk of developing major bleeding (RR, 0.12 [95% CI, 0.03-0.44]; ARR, 95 fewer episodes per 1000 [95% CI, 60 fewer to 104 fewer episodes per 1000]; very low certainty). 