Antithrombotic Guidelines, 9th Ed
The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines include 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 can also be found in the February 2012 issue of CHEST.
Print
The print issue contains the following 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 online through the ACCP Store.
Online
The complete guidelines — inclusive of detailed articles on individual topics, evidence profile tables, and more — is available in the online version of the February 2012 supplement to CHEST.
Mobile
Accessing via the CHEST app for the iPhone® and iPad®
The full guidelines can be accessed via the CHEST journal app for the iPhone and iPad. To access the guidelines through the app, you must have a subscription to CHEST and log in through the CHEST journal app. Subscriptions cannot be obtained through the app.
After logging in:
- 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 If the CHEST app is out of date, the guidelines issue will not appear.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 on the "Supplement" button. (See image to right.)
- Click on 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 obtained through the mobile website. CHEST subscribers can access the guidelines through the CHEST mobile website by following these simple steps:
- Go to journal.publications.chestnet.org/ on your mobile device.
- Enter your user name and password.
- From the home page, select "Previous Issues." (See image to right.)
- Select the issue labeled "February 2011 – 141(2 suppl):1S-e737S and then click on any article to view.
New Developments
This edition of the guidelines reflects a number of innovative procedural and methodologic advancements that have resulted in many changes in 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
Methodologic 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 ACCP antithrombotic guidelines. Physicians may incorporate any slides from these sets into their own presentations to explain and share the recommendations of the AT9 guidelines with other colleagues.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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).
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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.
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Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy
This slide set presents several recommendations focusing on the management of venous thromboembolism and thrombophilia. It also 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 also 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 is a quick reference to the AT9 guidelines for physicians. This guide lists each guideline and breaks it down by patient population, recommendation, and grade, in an easily searchable and convenient format for the practicing physician.
AT9 Quick Reference Guide
Podcasts
Listen to podcasts that feature discussions on methodology and key recommendations related to the ACCP Antithrombotic Guidelines, 9th ed.:
Advancing Evidence-Based Medicine: ACCP 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 Web site.
Access podcasts on iTunes.
Pocket Cards
Easily reference the ACCP Antithrombotic Guidelines, 9th ed, at the point-of-care with convenient guideline pocket cards. This practical tool contains screening, diagnostic, and treatment algorithms; drug therapy; dosing information; patient monitoring; and counseling points for antithrombotic therapy. The pocket cards are available for purchase and cover select antithrombotic guideline topics.
ACCP Evidence-Based Medicine
Learn more about additional ACCP 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 OneBreath®, an initiative of The CHEST Foundation, the philanthropic arm of the ACCP. The patient education guides include frequently asked questions that patients may have about clinical recommendations within the ACCP Antithrombotic Guidelines, 9th ed, and corresponding answers in lay terms.
Learn more about the ACCP Antithrombotic Guidelines, 9th ed, patient education guides.