We found no relevant systematic reviews but did identify 8 studies106-113 that included patients on DOACs receiving treatment of bleeding, some of whom had measurements of the DOAC anticoagulant effect using a variety of tests (eg, activated partial thromboplastin time, anti factor Xa concentrations, and thrombin time), but none had a primary objective of evaluating the impact of measuring DOAC anticoagulant effect or reported a direct comparison of outcomes for patients who did and did not receive DOAC anticoagulant effect measurement. Eight studies reported mortality as an outcome,106-113 reported development of thromboembolism,106,111 and 1 study assessed the occurrence of major bleeding during the 30 days following the index bleeding event.107 The EtD framework is shown online at https://dbep.gradepro.org/profile/9e7da133-8251-461a- 9a11-7b08b197a77e. Benefits. For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. After indirectly comparing the available evidence from separate studies, we found no difference in mortality between patients in whom the DOAC anticoagulant effect was measured and those in whom it was not measured, but CIs included appreciable mortality increases and decreases (RR, 1.28 [95% CI, 0.80-2.05]; ARR, 44 more deaths per 1000 [95% CI, 32 fewer to 166 more]; very low certainty). Harms and burden. Estimating the relative and absolute risk estimates was not possible, as there were no thromboembolic events in the intervention group and no bleeding events reported in the comparison group, leaving very low certainty evidence. Other EtD criteria and considerations. Very little evi- dence was available regarding other EtD criteria. Conclusions and research needs for this recommendation. 