For patients at low to moderate risk of recurrent VTE who require interruption of VKA therapy for invasive procedures, the ASH guideline panel recommends against periprocedural bridging with LMWH or UHF in favor of interruption of VKA alone (strong recommendation based on moderate certainty in the evidence about effects ). Recommendation 15. For patients interrupting DOAC therapy for scheduled invasive procedures, the ASH guideline panel suggests against performing laboratory testing for DOAC anticoagulant effect prior to procedures (conditional recom- mendation based on very low certainty in the evidence about effects ). Excessive anticoagulation and bleeding management Recommendation 16. For patients receiving VKA for treatment of VTE with INRs of .4.5 but ,10 and without clinically relevant bleeding, the ASH guideline panel suggests using temporary cessation of VKA alone without the addition of vitamin K (conditional recommendation based on very low certainty in the evidence about effects ). 27 NOVEMBER 2018 x VOLUME 2, NUMBER 22 ASH 2018 VTE GUIDELINES: ANTICOAGULATION MANAGEMENT 3259 Recommendation 17. For patients with life-threatening bleed- ing during VKA treatment of VTE who have an elevated INR, the ASH guideline panel suggests using 4-factor prothrombin complex concentrates (PCCs) rather than fresh-frozen plasma (FFP) as an addition to cessation of VKA and IV vitamin K (conditional recommendation based on very low certainty in the evidence about effects ). Recommendation 18a. For patients with life-threatening bleed- ing during oral direct Xa inhibitor treatment of VTE, the ASH guideline panel suggests using either 4-factor PCC administration as an addition to cessation of oral direct Xa inhibitor or cessation of oral direct Xa inhibitor alone (conditional recommendation based on very low certainty in the evidence about effects ). Remark: This recommendation does not apply to non life-threatening bleeding. 