Building on the systematic review that addressed PST and PSM,29 we performed a meta- analysis on 16 studies measuring outcomes for patients performing Table 3. Examples of drugs known to inhibit or induce P-gp and/or Inhibitors Strong inhibitors Antihypertensive/heart rate control Anti-infectives Verapamil Clarithromycin Dronedarone Telithromycin Anti-infectives Itraconazole Itraconazole Ketoconazole Ketoconazole Antidepressants Voriconazole Nefazodone Posaconazole Protease inhibitors Clarithromycin Atazanavir Darunavir Indinavir Lopinavir Nelfinavir Ritonavir Saquinavir Tipranavir Inducers Strong inducers Anti-infectives Anti-infectives Rifampin Rifampin Anticonvulsants Anticonvulsants Carbamazepine Carbamazepine Phenytoin Phenytoin Barbiturates Barbiturates Natural products Natural products St. John s wort St. John s wort Not an inclusive list. Available evidence reported the effects of various drugs that inhibit or induce P-gp or CYP3A4 on DOAC pharmacokinetic parameters, such as area under the plasma concentration time curve, maximal plasma DOAC concentration, and DOAC half- life. In general, these parameters are increased by P-gp or CYP3A4 inhibitors and decreased by inducers. No studies have reported different rates of bleeding, thromboembo- lism, or mortality between DOACs and a comparator (eg, VKA). Reference texts on tertiary drug interaction generally suggested observing patients for symptoms of bleeding or thromboembolism and to consider adjusting DOAC doses. Depending on the specific DOAC, product labeling in some cases suggested modification of DOAC dosing (eg, apixaban) or recommended avoiding the use of DOACs when interacting drugs were coprescribed (eg, rivaroxaban). Studies included patients requiring VKA therapy for various indications, mainly for indications other than VTE treatment. Eleven studies reported the effect of PSM on recurrent PE and DVT rates were estimated by extrapolating pooled relative thromboembolic to baseline recurrent VTE rates from the LMWH/VKA arms of recent RCTs. assessed major bleeding risk, and 9 reported information on TTR. Two studies evaluated the effect of PSM on quality of life.52,59 The EtD framework is shown online at https://dbep.gradepro.org/ profile/323c2cad-e2ab-4fd6-b35f-be34eee8219a. Benefits. 