For patients receiving VKA therapy for treatment of VTE, the ASH guideline panel suggests using an INR recall interval of 4 weeks or fewer rather than intervals longer than 4 weeks fol- lowing VKA dose adjustment due to an out-of-target-range INR (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. We found no systematic reviews or randomized trials that addressed this question. Three observational studies have evaluated the impact of INR recall interval on surrogate outcomes such as site-level TTR performance and TTR below No studies reported the risks of mortality, recurrent VTE, or bleeding. The EtD framework is shown online at https://dbep. gradepro.org/profile/768b8b3c-7ac2-48ff-a5d6-e13b7b0044cf. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. The panel was unable to estimate the magnitude of benefit for clinically important outcomes such as mortality, recurrent VTE, and bleeding. One study reported a decrease in site-level TTR of 1.12% (95% CI, 0.8%-1.43%) following each additional INR recall Another study reported that for patients measuring their own INRs at home and self-adjusting VKA doses, long intervals between INR measurements (.14 days) were associated with poor anticoagulation control (defined as percentage of in-range INRs 27 NOVEMBER 2018 x VOLUME 2, NUMBER 22 ASH 2018 VTE GUIDELINES: ANTICOAGULATION MANAGEMENT 3267 In this study, the temporal relationship between INR test interval and the outcome was unclear, and the outcome itself (poor anticoagulation control) would have an impact on the determination of the test interval. The study population was different from patients receiving INR monitoring and VKA dose adjustments from their anticoagulation providers. 