Efforts to improve anticoagulant- medication adherence Question: For patients receiving anticoagulation therapy for VTE, should interventions to improve adherence (eg, refill reminders and INR reminders) vs usual care be used? In general, adherence to prescribed medication regimens is associated with improved clinical outcomes for patients with chronic conditions, and nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, in- creased morbidity and mortality, and increased health care Initially, we searched for any evidence regarding specific interventions to improve anticoagulation therapy adherence (eg, refill reminders and INR reminders). We searched only for RCTs and identified 3 RCTs addressing specific interventions designed to improve adherence, and we prepared separate EtD frameworks for each adherence intervention (recommendations For patients receiving anticoagulation therapy for treatment of VTE, the ASH guideline panel suggests against using a daily lottery (between a 1-in-5 and 1-in-100 chance of a monetary reward each day if a pill compartment on a sophisticated elec- tronic medication monitoring system is accessed) to improve medication adherence (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. Two RCTs reported the effect of a daily lottery-based incentive intervention for patients using In the lottery arm, participants had between a 1-in-5 and a 1-in-100 chance of a monetary reward each day if they opened the pill compartment on a sophisticated electronic medication monitoring system and confirmed that they took their warfarin as prescribed that day. The main outcome was anticoagulation control, as measured by out-of-range INRs, and secondary outcomes included mortality, bleeding, and thromboembolic events. The EtD framework is shown online at https://dbep.gradepro.org/profile/ e5b45031-b8d4-4f50-8472-6617781ff3e3. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. 