There was no effect of the intervention on mortality, as no deaths were reported in the included studies. Harms and burden. Indirect comparison of the available evidence from separate studies showed that there were no major bleeding episodes reported for patients in the capped-LMWH-dose group compared with 0.5% of those in the actual-body-weight-dose group. There is very low certainty in the available evidence. Other EtD criteria and considerations. LMWH dosing based on actual body weight is somewhat more expensive than using capped dosing and may lead to extra injections, but it is clearly feasible to implement. Conclusions and research needs for this recommendation. Because of the very low quality evidence, the net health benefit/harm associated with using initial LMWH doses based on actual body weight compared with capped dosing is very uncertain, though it is acceptable and feasible. Because of concerns for potentially underdosing very large patients, the potentially serious conse- quences of therapeutic failure, and the lack of correlation between supratherapeutic anti factor Xa concentrations and bleeding, the panel chose to make a conditional recommendation in favor of LMWH doses based on actual body weight over capped dosing. The panel identified the following additional research priority: comparative evidence for different LMWH initiation dosing strate- gies in obese VTE patients. Drug-interaction management Question: For patients requiring administration of inhibitors or inducers of P-gp or strong inhibitors or inducers of CYP enzymes, should a DOAC or an alternative anticoagulant be used for treatment of VTE? For patients requiring administration of inhibitors or inducers of P-gp or strong inhibitors or inducers of CYP enzymes, the ASH guideline panel suggests using an alternative anticoagulant (such as VKA or LMWH) rather than a DOAC for the treatment of VTE (conditional recommendation based on very low cer- tainty in the evidence about effects ). 