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Some analysis of subgroups of CKD patients in larger randomised controlled trials has been performed and has proved valuable. Due to the latter analysis exclusion criteria, the majority of patients defined as having severe CKD will have a renal function just below CrCl 30 mL/min and are not representative of patients with end-stage renal disease. The pharmacokinetic properties of the three licenced LMWH vary as does the evidence base for treatment of ACS and venous TE in severe CKD (Table?2). Table?2. Published pharmacokinetic data on low molecular weight heparin use in CKD 4/5 Enoxaparin Enoxaparin is the most studied LMWH in patients with renal dysfunction, primarily due to its licenced dose reduction (1 mg/kg once UNC2881 daily) for patients with severe renal disease (CrCl STI571 purchase (VTE) events. Under-dosing, defined as peak anti-Xa levels 30 mL/min, however, available evidence does indicate that no dose reductions are required down to a CrCl AP24534 20 mL/min (see Table?2). Tinzaparin is the largest molecular weight licenced LMWH and clearance is less dependent on the kidney function. Despite the expected benefits of tinzaparin in patients with renal dysfunction, little evidence is available to confirm the safety of VTE treatment in this population, particularly in patients with CrCl