Because very few events occur for patients at low to moderate risk for recurrent VTE, the magnitude of the absolute effect, whatever the true relative effect, will be very small, and the certainty in evidence for recurrent VTE was upgraded (RR, 0.34 [95% CI, 0.02-6.58]; ARR, 2 fewer DVTs certainty). Harms and burden. The risk of clinically relevant bleeding was increased among those receiving bridging with LMWH compared with those who interrupted warfarin therapy alone (RR, per 1000 [95% CI, 3 more to 196 more per 1000]; very low certainty). Bridging with LMWH was associated with lower patient satisfaction (MD, 0.5 lower [95% CI, 0.25 lower to 0.75 lower]; low certainty) and increased the risk of delay in intervention, as measured by a composite of prolonged hospitalization and hematoma requiring interruption of anticoagulation or evacuation (RR, 4.57 [95% CI, 2.49-8.38]; ARR, 125 more delayed interventions per 1000 [95% CI, 52 more to 258 more]; low certainty). Other EtD criteria and considerations. The resource requirements associated with LMWH bridging are likely to be large, driven by the LMWH cost, complexity of teaching patients the intervention, and management of bleeding events. Conclusions and research needs for this recommendation. When the evidence for this question was weighed, a much higher value was placed on the risk for bleeding, which has been consistently associated with LMWH bridging in available studies, than on the possible reduction in the risk of recurrent VTE, which in this patient population is very small. The panel was confident that that the desirable effects of LMWH bridging are outweighed by the undesirable effects and that a strong recommendation against LMWH bridging was warranted. This recommendation does not apply to patients requiring VKA therapy for indications in addition to VTE (eg, mechanical heart valves). 