CHEST Guidelines-Introduction-to-the-Ninth-Edition

Introduction-to-the-Ninth-Edition_chest

Pdf Summary

The "Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition" (AT9) of the American College of Chest Physicians (ACCP) guidelines represents a significant evolution from its predecessors, both in methodology and content. This edition reflects a concerted effort to improve guidelines through methodological rigor, transparency, and addressing conflicts of interest.<br /><br />The foundational work for these guidelines was started by visionaries like James E. Dalen and Jack Hirsh in 1986. Dr. Hirsh emphasized the importance of evidence-based medicine and the need to separate clinical expertise from guideline authorship to avoid conflicts of interest.<br /><br />Compared to previous editions, AT9 introduces several major innovations. One key change is assigning leadership of the guideline sections to methodologists who are largely free from conflicts of interest. This approach helps ensure impartiality in the creation and endorsement of recommendations. Extensive use of evidence profiles and summary tables improves transparency in how the quality of evidence and recommendation strengths are determined.<br /><br />The guidelines detail the importance of differentiating between patient-important and surrogate outcomes to provide recommendations that truly reflect patient priorities and needs. A notable change in AT9 is the reassessment and inclusion of aspirin as a potential thromboprophylactic agent in orthopedic surgeries, previously not recommended.<br /><br />A rigorous application of the GRADE methodology, which assesses and summarizes the quality of evidence and strength of recommendations, has influenced the construction of AT9. This leads to a generally more conservative set of recommendations, with a higher prevalence of weak recommendations due to a critical re-evaluation of evidence quality and variability in patient preferences.<br /><br />Overall, AT9 marks a shift towards a more meticulous, conflict-free approach to guideline development, emphasizing the incorporation of methodologically robust processes and responding to the evolving landscape of available evidence in antithrombotic therapy.

Keywords

AT9 guidelines

American College of Chest Physicians

antithrombotic therapy

thrombosis prevention

evidence-based medicine

conflicts of interest

GRADE methodology

aspirin thromboprophylaxis

methodological rigor

patient-important outcomes