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Home Guidelines & Resources Antithrombotic Guidelines, 9th Ed

Antithrombotic Guidelines, 9th Ed

The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: CHEST Evidence-Based Clinical Practice Guidelines connects you to more than 600 recommendations for the prevention, diagnosis, and treatment of thrombosis, addressing a comprehensive list of clinical conditions, including medical, surgery, orthopedic surgery, atrial fibrillation, stroke, cardiovascular disease, pregnancy, and neonates and children.

How to Access

The guidelines are published as a supplement to the February 2012 issue of CHEST and are available in print, online, and through mobile devices. A corresponding editorial is also in the February 2012 issue of CHEST.

Print

The print issue contains three articles, inclusive of all recommendations:

  • Executive Summary
    • Introduction to the Ninth Edition
  • Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines

The print issue can be ordered through our online store.

Online

The complete guidelines—inclusive of detailed articles on individual topics, evidence profile tables, and more—is available electronically in the February 2012 supplement to CHEST.

Mobile

Accessing via the app for the iPhone® and iPad®

To access the guidelines through the app, you must first be a CHEST subscriber and then log in through the journal app. Subscriptions cannot be purchased through the app.

After logging in:

  1. Make sure the CHEST app is up to date. Version 3.1 of the app was released in iTunes® and the App Store on February 1, 2012. If the CHEST app is out of date, the guidelines issue will not appear. To check, launch the App Store icon and select "Updates." Select the CHEST app and click “Update.” You will need to enter your iTunes password.
    • Once the app is updated, launch the CHEST app.
        • Click the "Supplement" button (see image to right).
          • Click any article title to navigate the text, figures, and tables.

          Accessing via CHEST Mobile Website

          To access the full guidelines on the mobile site, you must have a subscription to CHEST and be logged in. Subscriptions cannot be purchased through the mobile website. CHEST subscribers can access the guidelines through the CHEST mobile website by following these simple steps:

          1. Go to journal.publications.chestnet.org on your mobile device.
          2. Enter your user name and password.
          3. From the home page, select "Previous Issues" (see image to right).
          4. Select the issue labeled "February 2011 – 141(2 suppl):1S-e737S," then click on any article to view.

          New Developments

          This edition of the guidelines reflects a number of innovative procedural and methodological advancements that have resulted in many changes to the recommendations, both clinically and in terms of the strength of the recommendations.

          Clinical Features

          • A focus on the risk stratification of patients, suggesting clinicians should consider a patient’s risk for DVT/VTE and risk for bleeding before administering or prescribing a prophylactic drug or device
          • The inclusion of aspirin as a potential option for the prevention of DVT/VTE in select patients undergoing major orthopedic surgery
          • Expanded discussion and recommendations related to perioperative management of VTE
          • The inclusion of new antithrombotic therapies
          • Detailed risk factors and recommendations associated with long-distance travel and DVT/VTE
          • The division of prevention into three major areas: medical patients, orthopedic surgery patients, and other surgical patients
          • The inclusion of an article devoted to diagnosis

          Methodological Features

          • A more critical look at the overall process of guideline development, providing more methodologically sophisticated scrutiny of all available evidence
          • Expanded explicit and quantitative consideration of patient values and preferences
          • Restriction of outcomes to only those deemed to be patient-important 

          Clinician Resources

          Educational Slide Sets for Physicians

          This clinical resource is a series of educational slide sets for physicians, each set corresponding to the recommendations in chapters in the ninth edition of the antithrombotic guidelines. Incorporate slides from these sets into your own presentations to explain and share the recommendations of the AT9 guidelines with colleagues.

          • Evidence-Based Management of Anticoagulant Therapy
            This slide set presents several recommendations related to the general management of anticoagulant therapy. Specifically, it covers initiation, maintenance, dosing, drug interactions, bleeding, and organization of care, offering guidance for many common anticoagulation-related management problems.

          • Prevention of Venous Thromboembolism in Nonsurgical Patients
            This slide set presents several recommendations regarding the decisions in prophylaxis in nonsurgical patients, taking into consideration risk factors for both thrombosis and bleeding, clinical context, and patients’ values and preferences. These recommendations incorporate perspectives in bleeding disorders, critical care, preventive medicine, methodology, and cost effectiveness.

          • Prevention of Venous Thromboembolism in Nonorthopedic Surgical Patients
            This slide set presents several recommendations regarding optimal thromboprophylaxis in nonorthopedic surgical patients and considers the risks of venous thromboembolism and bleeding complications, as well as the values and preferences of individual patients.

          • Prevention of Venous Thromboembolism in Orthopedic Surgery Patients
            This slide set presents several recommendations regarding the optimal strategies for thromboprophylaxis after major orthopedic surgery, including pharmacologic and mechanical approaches, to reduce patient-important outcomes, such as pulmonary embolism and symptomatic DVT.

          • The Perioperative Management of Antithrombotic Therapy
            This slide set presents several recommendations to simplify patient management and minimize adverse clinical outcomes for perioperative antithrombotic management based on risk assessment for thromboembolism and bleeding.

          • Diagnosis of DVT
            This slide set presents several recommendations for diagnosis of first DVT, including a combined use of pretest probability assessment, D-dimer, and ultrasound.

          • Antithrombotic Therapy for Venous Thromboembolic Diseases
            This slide set presents several recommendations regarding general antithrombotic therapy for VTE, highlighting the strong recommendations that apply to most patients and the weak recommendations that are sensitive to differences among patients, including their preferences.

          • Treatment and Prevention of Heparin-Induced Thrombocytopenia
            This slide set presents several recommendations regarding heparin-induced thrombocytopenia and the primary efficacy outcome measures of interest, including new thrombosis, limb amputation, and major bleeding and death due to thrombosis or bleeding.

          • Antithrombotic Therapy in Atrial Fibrillation
            This slide set presents several recommendations regarding atrial fibrillation based on net clinical benefit for patients at varying levels of stroke risk and in a number of common clinical scenarios.

          • Antithrombotic and Thrombolytic Therapy for Valves
            This slide set presents several recommendations based on the optimal balance of thrombotic and hemorrhagic risk for antithrombotic therapy in valvular disease.

          • Antithrombotic and Thrombolytic Therapy for Ischemic Stroke
            This slide set presents several recommendations on the use of antithrombotic therapy in patients with stroke or transient ischemic attack.

          • The Primary and Secondary Prevention of Cardiovascular Disease
            This slide set presents several recommendations focusing on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies (ticagrelor and prasugrel).

          • Antithrombotic Therapy in Peripheral Artery Disease
            This slide set presents several recommendations regarding antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in patients with peripheral arterial disease (PAD). The slide set highlights single antiplatelet therapy for primary and secondary prevention of cardiovascular events in most patients with asymptomatic PAD, symptomatic PAD, and asymptomatic carotid stenosis.

          • Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy
            This slide set presents several recommendations focusing on the management of venous thromboembolism and thrombophilia. It discusses the use of antithrombotic agents during pregnancy and the associated challenges because of the potential for both fetal and maternal complications.

          • Antithrombotic Therapy in Neonates and Children
            This slide set presents several recommendations focusing on the monitoring to specific target ranges for both unfractionated and low-molecular-weight heparins in neonates and children. It acknowledges the ongoing need for dedicated clinical trials that demonstrate the differences in the pharmacokinetics, dose responses, and monitoring tests for anticoagulation therapy in children compared with adults.

          AT9 Quick Reference Guide

          This quick reference to the AT9 guidelines for physicians lists each guideline and breaks it down by patient population, recommendation, and grade in an easily searchable and convenient format.

          AT9 Quick Reference Guide

          Podcasts

          Listen to podcasts featuring discussions on methodology and key recommendations related to the guidelines:

          Advancing Evidence-Based Medicine: CHEST Methodology
          with Gordon H. Guyatt, MD, FCCP, and Ian T. Nathanson, MD, FCCP

          New Drugs, New Recommendations: What Clinicians Must Know
          with Mark A. Crowther, MD, and David A. Garcia, MD

          Access podcasts on the CHEST Journal Web site.

          Access podcasts on iTunes.

          CHEST Evidence-Based Medicine

          Learn more about other evidence-based guidelines and consensus statements and related courses on the methodology of guideline development.

          New Patient Resources

          Patient Education Guides

          A patient education guide series is available for download from The CHEST Foundation, our philanthropic arm. The patient education guides include frequently asked questions that patients may have about clinical recommendations within the guidelines and corresponding answers in lay terms. Learn more.

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