The acquisition cost of idarucizumab is considerable, although no formal economic analyses are available. Conclusions and research needs for this recommendation. There is very low certainty evidence for a net health benefit from using idarucizumab to manage life-threatening bleeding for patients re- ceiving dabigatran therapy for VTE, mandating a conditional recommendation. Some panel members were concerned about the possibility of VTE following idarucizumab administration. Furthermore, this recommendation does not apply to patients with non life- threatening bleeding, as the cost likely outweighs the potential benefit. The panel identified the following additional research questions. (1) What variables define the need for intervention with idarucizumab over withholding dabigatran alone? (2) What is the comparative effective- ness of idarucizumab in real-world patients presenting with potentially life-threatening dabigatran-associated bleeding compared with dabi- gatran cessation alone? (3) Would the use of a rapidly available test for a dabigatran effect prevent administration of idarucizumab to patients who do not have significant dabigatran concentrations? Question: For patients with life-threatening bleeding during LMWH or UFH treatment of VTE, should cessation of LMWH or UFH plus protamine vs cessation of LMWH or UFH alone be used? For patients with life-threatening bleeding during LMWH or UFH treatment of VTE, the ASH guideline panel suggests using prot- amine in addition to cessation of LMWH or UFH rather than no protamine (conditional recommendation based on very low cer- tainty in the evidence about effects ). Remark: This rec- ommendation does not apply to non life-threatening bleeding. Summary of the evidence. 