Anticoagulant resumption following bleeding Question: For patients receiving anticoagulant treatment of VTE who survive an episode of major bleeding, should resumption of oral anticoagulation therapy vs discontinuation of oral anticoagu- lation therapy be used? For patients receiving anticoagulation therapy for VTE who survive an episode of major bleeding, the ASH guideline panel suggests resumption of oral anticoagulation therapy within 90 days rather than discontinuation of oral anti- coagulation therapy (conditional recommendation based on very low certainty in the evidence about effects ). Remark: This recommendation specifically applies to pa- tients who require long-term or indefinite anticoagulation (ie, are at moderate to high risk for recurrent VTE, are not at high risk for recurrent bleeding, and are willing to continue anti- coagulation therapy). Summary of the evidence. We included eligible studies from the most recent systematic review for patients who did and did not resume anticoagulation therapy after surviving an episode of gastrointestinal tract bleeding (GIB).216 The search was updated from 2014 onward and expanded to include ICH, yielding a total of Most studies compared outcomes for patients who did and did not resume anticoagulation therapy following a GIB or ICH episode. Follow-up periods varied between studies (range, 3 months to 10 years). Six studies reported the effect of anticoagulation therapy resumption on all-cause mortality,218,219,222,229,230,233 6 studies reported devel- opment of PE,218,223,225,227,229,230 7 studies reported development 9 studies reported the occurrence of VTE (PE, DVT, or both),218-220,222,223,225,227,229,230 reported development of thromboembolism (including events other and 14 studies reported worsening or new bleeding.217-220,222,223,225,227-233 The EtD frame- work is shown online at https://dbep.gradepro.org/profile/098f8dae- 062b-41b2-a51e-f7cc74379f3a. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. 