For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. Indirect comparison of the available evidence from separate studies showed that laboratory testing to assess DOAC effect prior to invasive procedures may or may not reduce mortality (RR, 0.47 fewer to 8 more]; very low certainty) and VTE (RR, 0.37 [95% CI, more]; very low certainty). Harms and burden. Indirect comparison of the available evidence from separate studies showed that laboratory testing to assess DOAC effect prior to invasive procedures had no effect on the risk of major bleeding compared with interrupting DOAC alone [95% CI, 10 fewer to 15 more per 1000]; very low certainty). Other EtD criteria and considerations. There is very little evidence bearing on other EtD criteria. Conclusions and research needs for this recommendation. The net health benefit/harm from laboratory testing to assess DOAC effect prior to scheduled invasive procedures compared with interrupting DOAC therapy remains very uncertain. Further- more, the clinical use of DOAC tests is not well established, and there is no evidence to support a beneficial effect. Therefore, the panel made a conditional suggestion against confirming the absence of DOAC effect prior to proceeding with scheduled invasive procedures. Confirming the absence of DOAC affect may be advisable in scenarios where anticoagulant effect may be prolonged (eg, patients with renal dysfunction and/or on interacting drugs), when DOAC interruption cannot be reliably confirmed by the patient/caregiver (eg, urgent or emergent invasive procedures), or for patients undergoing a procedure that entails a very high risk of bleeding. 