For patients with creatinine clearance of $50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored every 6 to 12 mo vs no such monitoring? 23. For patients with creatinine clearance of ,50 mL/min receiving DOAC therapy for treatment of VTE, should renal function be monitored more frequently (every 3 mo) vs no such monitoring? Reporting of outcomes was inconsistent across studies. Some studies assessed thromboembolic and bleeding outcomes for indications other than VTE; in these cases, those results were extrapolated to PE and DVT outcomes and used to estimate the relative effects on prioritized outcomes. In such instances, the panel rated down certainty for indirectness. Evidence review and development of recommendations For each guideline question, the McMaster GRADE Centre prepared a GRADE EtD table, using the GRADEpro Guideline Development Tool The EtD table summarized the results of systematic reviews of the literature that were updated or performed specifically for these guidelines. The EtD table addressed desirable and undesirable effects of interventions, certainty in the evidence, values and preferences (relative importance of outcomes), resource use, health equity, acceptability, and feasibility. The guideline panel reviewed draft EtD tables before, during, or after the guideline panel meeting and made suggestions for improvement. To ensure that recent studies were not missed, searches (presented in supplement 4) were updated during February and March 2017, and panel members remained alert for new eligible studies and could bring these to the panel for potential inclusion. Under the direction of the McMaster GRADE Centre, researchers followed the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions (handbook.cochrane.org) for conducting updated or new systematic reviews of intervention effects. When existing reviews were used, judgments of the original authors regarding risk of bias were accepted and checked for accuracy or conducted de novo. 