Recommendations Initial anticoagulant dose selection Question: In obese patients receiving LMWH therapy for treatment of acute VTE, should initial LMWH dose selection according to 27 NOVEMBER 2018 x VOLUME 2, NUMBER 22 ASH 2018 VTE GUIDELINES: ANTICOAGULATION MANAGEMENT 3263 actual body weight vs dose selection based on a fixed maximum daily dose (ie, capped dose) be used? In obese patients receiving LMWH therapy for treatment of acute VTE, the ASH guideline panel suggests initial LMWH dose selection according to actual body weight rather than dose selection based on a fixed maximum daily dose (ie, cap- ped dose) (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. We found no systematic reviews but did identify 5 relevant individual studies.23-27 No study evaluated a direct comparison between LMWH doses based on actual body weight and capped doses for patients with obesity; thus, intervention and control studies represent different populations. Two studies included mortality as an outcome,23,24 5 studies reported development of and 5 studies reported major bleeding outcomes.23-27 The EtD framework is shown online at https://dbep.gradepro.org/profile/ 18c9f7b9-df8a-45ec-a63a-4f517a3a23d6. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. After indirectly comparing the available evidence from separate studies, we found no difference in VTE between those receiving LMWH dosed according to actual body weight and capped LMWH doses, but confidence intervals (CIs) included the possibility of appreciable benefit and harm (relative risk [RR], 0.76 [95% CI, 0.11- 5.45]; absolute RR [ARR], 5 fewer events per 1000 [95% CI, 19 fewer to 95 more per 1000]; very low certainty). There was no effect of the intervention on mortality, as no deaths were reported in the included studies. Harms and burden. 