For patients receiving VKA for treatment of VTE with INRs of .4.5 but ,10 and without clinically relevant bleeding, the ASH guideline panel suggests using temporary cessation of VKA alone without the addition of vitamin K (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. We included eligible studies from the most recent systematic review in nonbleeding patients who did and did not receive oral vitamin K for an INR of .4.5 but ,10 (or the upper limit of the laboratory INR readout).175 The search was updated from 2006 onward, yielding a total of 5 RCTs.176-180 Three studies reported the effect of vitamin K administration on 2 studies reported on development of any thromboembolism and major bleeding,176,179 1 study reported the outcome of DVT,176 and 5 studies reported the proportion of patients who reached various INR goal ranges.176-180 No studies reported the outcomes of emergency department visits, hospitalization, or quality- of-life impairment. The EtD framework is shown online at https://dbep. gradepro.org/profile/a457eb13-cb1d-40a8-a081-5e0c535d2a49. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. Administration of oral vitamin K in addition to withholding VKA did not reduce the risk of all-cause mortality compared with withholding VKA alone (RR, 1.24 [95% CI, 0.62- per 1000]; moderate certainty) or affect the proportion of patients who achieved the target INR (RR, 1.95 [95% CI, 0.88-4.33]; ARR, 165 more per 1000 [95% CI, 21 fewer to 579 more per 1000]; very low certainty), but the CI for both mortality and INR goal attainment includes appreciable reduction and increase in events. 