Policy-making will require substantial debate and involvement of various stakeholders. Performance measures should assess whether decision-making is appropriate. Researchers The recommendation is supported by credible research or other convincing judgments that make additional research unlikely to alter the recommendation. On occasion, a strong recommendation is based on low or very low certainty in the evidence. In such instances, further research may provide important information that alters the recommendations. The recommendation is likely to be strengthened (for future updates or adaptation) by additional research. An evaluation of the conditions and criteria (and the related judgments, research evidence, and additional considerations) that determined the conditional (rather than strong) recommendation will help identify possible research gaps. enzymes are involved in the metabolism of oral direct Xa inhibitors, but not dabigatran, and strong inhibitors of CYP3A4 enzymes potentially decrease the metabolism and increase direct Xa inhibitor effect, whereas inducers of CYP3A4 enzymes potentially increase the metabolism and decrease direct Xa inhibitor effect. It is uncertain whether patients who require coadministration of potentially interact- ing drugs (see Table 3) and DOACs would have better outcomes if instead of a DOAC they received another anticoagulant. We found no systematic reviews that addressed this question. There were no randomized trials that addressed the outcomes prioritized for this question. Available evidence was very limited and consisted of pharmacokinetic studies with small sample sizes, subgroup analysis of clinical trials,28 information from product labeling, and drug- interaction reference texts. The EtD framework is shown online at 03ff16ff4bbb. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. Theoretically, the concurrent use of P-gp or CYP3A4 inducers could decrease DOAC benefits, but the panel was unable to estimate the magnitude of decrease, if any. Harms and burden. 