Executive Summary Antithrombotic Therapy and Prevention of Thrombosis , 9 th ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

T eighth iteration of the American College of Chest Physicians Antithrombotic Guidelines presented, in a paper version, a narrative evidence summary and rationale for the recommendations, a small number of evidence profi les summarizing bodies of evidence, 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 Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) without sacrifi cing 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 systematic review 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 explain this innovation to users of AT9, and this meant another article. We included, for the fi rst time, an article on diagnosis addressing patients with symptoms and signs suggesting DVT. We increased the range of interventions we have covered, resulting in additional recommendations. Finally, we produced many summary of fi ndings tables, which offer extremely succinct and informative presentations of best estimates of effect and the confi dence associated with those estimates. If published in the same fashion as the Antithrombotic and Thrombolytic Therapy, 8th ed: American Abbreviations: ACS 5 acute coronary syndrome; AF 5 atrial fi brillation; 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 of Chest 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; CHADS 2 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 pulmonary hypertension; 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 5 intermittent 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 modifi ed BlalockTaussig shunt; MR 5 magnetic resonance; PAD 5 peripheral artery disease; PCI 5 percutaneous coronary inter vention; 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 5 upperextremity DVT; UFH 5 unfractionated heparin; US 5 ultrasound; UVC 5 umbilical venous catheter; VAD 5 ventricular assist device; VKA 5 vitamin K antagonist Executive Summary