Ultimately, the strategy for transitioning from DOAC to VKA should be based on patient preference and willingness to use and ability to afford injections. The panel identified the following research priority: sufficiently powered pragmatic clinical trials comparing thromboembolic and bleeding outcomes for DOAC overlap vs LMWH-bridging therapy for patients transitioning from DOAC to VKA. Use of specialized AMSs Question: For patients receiving anticoagulation therapy for treatment of VTE, should specialized AMS care vs care provided by the patient s regular health care provider be used for anti- coagulation management? For patients receiving anticoagulation therapy for treatment of VTE, the ASH guideline panel suggests using specialized AMS care rather than care provided by the patient s regular health care provider (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. We found evidence from both RCTs and observational studies and systematic reviews addressing this question. There was considerable discussion among panel members regarding the type of evidence that best represented the outcomes of contemporary anticoagulant therapy. Evidence sum- maries prepared for RCTs and observational studies revealed that evidence certainty was very low regardless of study type. After careful review of the included studies, the panel decided to use evidence summarized from observational studies, as these best reflected real-world anticoagulation therapy management practices. Although not required under ASH policy, 4 panelists, including the chair (N.P.C., Ann Wittkowski, J.S., and D.M.W.), recused themselves from making judgments about the evidence or deciding the recommendation thereafter, because they viewed their roles as directors of large anticoagulation clinics to be a professional and/or intellectual conflict of interest. R.N. led the panel discussion assessing both RCT and observational evidence instead of D.M.W. 