Confirming the absence of DOAC affect may be advisable in scenarios where anticoagulant effect may be prolonged (eg, patients with renal dysfunction and/or on interacting drugs), when DOAC interruption cannot be reliably confirmed by the patient/caregiver (eg, urgent or emergent invasive procedures), or for patients undergoing a procedure that entails a very high risk of bleeding. It is advisable not to rely on any single (either pharmacokinetic or laboratory) strategy in isolation to assess DOAC effect prior to procedures but instead to use a comprehen- sive approach to assessing, confirming, and communicating DOAC cessation of therapy among the patient and all providers involved. The panel identified the following additional research priorities: (1) developing validated specific DOAC effect tests, particularly those that can be performed rapidly and, ideally, at the point of care; (2) testing the effect on clinical outcomes of using a validated specific DOAC test with prespecified thresholds at which patients on DOACs can safely proceed to surgery or invasive diagnostic procedures; (3) assessing the cost-effectiveness, acceptability, and feasibility of implementing a validated specific DOAC test. Excessive anticoagulation and bleeding management. Question: For patients receiving VKA for treatment of VTE with INRs of .4.5 but ,10 and without clinically relevant bleeding, should temporary cessation of VKA plus administration of vitamin K vs temporary cessation of VKA alone be used? 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 ). Summary of the evidence. 