2012 Antithrombotic Therapy And Prevention Of Thrombosis

CHEST
Executive Summary

Supplement

ANTITHROMBOTIC THERAPY AND PREVENTION OF THROMBOSIS, 9TH ED: ACCP GUIDELINES

Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Gordon H. Guyatt, MD, FCCP; Elie A. Akl, MD, PhD, MPH; Mark Crowther, MD; David D. Gutterman, MD, FCCP; Holger J. Schünemann, MD, PhD,FCCP; for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel*

CHEST 2012; 141(2)(Suppl):7S–47S
Abbreviations: ACS 5 acute coronary syndrome; AF 5 atrial fibrillation; AIS 5 arterial ischemic stroke; APLA 5 antiphospolipid antibodies; ASA 5 acetylsalicylic acid; AT9 5 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College ofChest Physicians Evidence-Based Clinical Practice Guidelines; BMS 5 bare-metal stent; CABG 5 coronary artery bypass graft; CAD 5 coronary artery disease; CDT 5 catheterdirected thrombosis; CHADS2 5 congestive heart failure, hypertension, age 75 years, diabetes mellitus, prior stroke or transient ischemic attack; CSVT 5 cerebral sinovenous thrombosis; CTPH 5 chronic thromboembolic pulmonaryhypertension; CUS 5 compression ultrasound; CVAD 5 central venous access device; DES 5 drug-eluting stent; GCS 5 graduated compression stockings; HFS 5 hip fracture surgery; HIT 5 heparin-induced thrombocytopenia; HITT 5 heparin-induced thrombocytopenia complicated by thrombosis; IA 5 intraarterial; ICH 5 intracerebral hemorrhage; IE 5 infective endocarditis; INR 5 international normalized ratio; IPC 5intermittent pneumatic compression; IPCD 5 intermittent pneumatic compression device; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecularweight heparin; LV 5 left ventricular; MBTS 5 modified BlalockTaussig shunt; MR 5 magnetic resonance; PAD 5 peripheral artery disease; PCI 5 percutaneous coronary intervention; PE 5 pulmonary embolism; PFO 5 patent foramen ovale;PMBV 5 percutaneous mitral balloon valvotomy; PTS 5 postthrombotic syndrome; PVT 5 prosthetic valve thrombosis; r-tPA 5 recombinant tissue plasminogen activator; RVT 5 renal vein thrombosis; SC 5 subcutaneous; TEE 5 transesophageal echocardiography; THA 5 total hip arthroplasty; TIA 5 transient ischemic attack; TKA 5 total knee arthroplasty; UAC 5 umbilical arterial catheter; UEDVT 5upperextremity DVT; UFH 5 unfractionated heparin; US 5 ultrasound; UVC 5 umbilical venous catheter; VAD 5 ventricular assist device; VKA 5 vitamin K antagonist

of The eighth iteration of the American CollegepreChest Physicians Antithrombotic Guidelines sented, in a paper version, a narrative evidence summary and rationale for the recommendations, a small number of evidence profiles summarizing bodies ofevidence, and some articles with quite extensive summary tables of primary studies. In total, this represented 600 recommendations summarized in 968 pages of text. Many readers responded that the result was too voluminous for their liking or practical use. Cognizant of this feedback, we worked hard to minimize the length of the text for the ninth iteration of the guidelines Antithrombotic Therapyand Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) without sacrificing key content. A number of topic editors found our shortening edits draconian, but we were determined to produce the leanest product possible. There were, however, a number of obstacles. In what we believe is a key advance in AT9, we conducted a systematicreview of what is known about patients’ values and preferences regarding antithrombotic therapy and included the results as an article in AT9. In another forward step, we recognized the problems with asymptomatic thrombosis as a surrogate outcome, and devised strategies to estimate reductions in symptomatic DVT and pulmonary embolism with antithrombotic prophylaxis. We felt it important to...