For patients transitioning from DOAC to VKA, the ASH guideline panel suggests overlapping DOAC and VKA therapy until the INR is within the therapeutic range over using LMWH- or UFH-bridging therapy (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. We found no systematic reviews but did identify 3 studies114-116 that included patients with atrial fibrillation, not VTE, transitioning from DOAC therapy to VKA therapy at the conclusion of RCTs. Three studies reported mortality outcomes, but only in the group overlapping DOAC during the transition ; 1 study reported development of thromboembolic ; and 1 study reported development of hemorrhagic stroke.115 No studies reported outcomes related to quality-of-life impairment. The EtD framework is shown online at https://dbep.gradepro.org/ profile/b1889d83-5875-453f-b047-fb742c25e43e. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. The effect of LMWH-bridging therapy on mortality risk during the transition from DOAC to VKA could not be estimated because data on deaths during the 30-day follow-up period were not available for the intervention group, leaving very low certainty regarding the impact of the alternative management strategies. Harms and burden. LMWH-bridging therapy during the transition from DOAC to VKA may increase the risk for VTE compared with overlapping DOAC therapy (RR, 5.58 [95% CI, more per 1000]; very low certainty). In the eligible studies, the LMWH- bridging strategy was implemented only when the patient was at high thromboembolic risk; thus, intervention and control groups had important differences. 