Very little evi- dence was available regarding other EtD criteria. Conclusions and research needs for this recommendation. Considering that only very low quality evidence is available regarding the net health benefit/harm from measuring the DOAC anticoagulant effect during management of bleeding, clinical use of DOAC tests is not well established, and no evidence supports a beneficial effect, the panel judged that it is better not to delay intervention for bleeding while waiting for a DOAC test result. It is advisable not to rely on any single (either pharmacokinetic or laboratory) strategy in isolation to assess DOAC effect during bleeding management but instead to use a comprehensive approach to assessing, confirming, and communicat- ing when the last DOAC dose was administered among the patient and all providers involved. The panel identified the following additional research priorities: (1) developing validated specific DOAC effect tests, particularly those that can be performed rapidly and, ideally, at the point of care; (2) testing the effect on clinical outcomes of using a validated specific DOAC test for patients with bleeding; and (3) assessing the cost-effectiveness, acceptability, and feasibility of implementing a validated specific DOAC test during bleeding management. Transitions between anticoagulants Question: For patients transitioning from DOAC to VKA, should LMWH or UFH bridging therapy vs overlapping DOAC therapy be used until the INR is within the therapeutic range? For patients transitioning from DOAC to VKA, the ASH guideline panel suggests overlapping DOAC and VKA therapy until the INR is within the therapeutic range over using LMWH- or UFH-bridging therapy (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. 