Reflecting on Eight Editions of the American College of Chest Physicians Antithrombotic Guidelines
Jack Hirsh, MD, FCCP, Gordon Guyatt, MD, FCCP, and Sandra Zelman Lewis, PhD
Abstract
The American College of Chest Physicians (ACCP) guidelines addressing antithrombotic therapy, first published in 1986,1 have been updated about every 3 years. The eighth edition of the guidelines [now called “Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)]” is published as a special supplement of CHEST this month.2 Over the past 2 decades, these guidelines have adapted to trends in evidence-based medicine and helped to raise the standards for guideline methodology.345678 The eighth edition has, judging by the numerous daily requests for the publication date, been one of the most anxiously anticipated products of the ACCP.
This document provides an extensive update of evidence-based guidelines for the management of thromboembolic conditions affecting the venous and arterial systems (including the coronary, cerebral, and peripheral arteries), and the cardiac chambers, including native and prosthetic valves. The guidelines also address the management of thromboembolism in the pediatric population and during pregnancy, the management of patients who are treated with anticoagulants and require bridging therapy because of an intercurrent invasive procedure, and the management of heparin-induced thrombocytopenia. We also include chapters reviewing the pharmacology of the approved anticoagulants (heparin, low-molecular-weight heparins, fondaparinux, hirudin, bivalirudin, and argatroban), antiplatelet drugs (aspirin, clopidogrel, ticlopidine, dipyridamole, and the glycoprotein IIb/IIIa antagonists), and thrombolytic agents (streptokinase, tissue plasminogen activator, and the tissue plasminogen activator analogs tenecteplase and retoplase). These introductory chapters include recommendations for the dosing and monitoring of anticoagulants and antiplatelet agents.
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| 3 | This guideline is reviewed on an annual basis. The HSP Committee determined that new studies have been published that warrant an update of the (fill in) chapter/section of this practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating and these recommendations remain current. |
| 4 | This guideline is reviewed on an annual basis. The HSP Committee determined that new data are available that are sufficient to potentially change guideline recommendations and a full revision is warranted. |
| 5 | This guideline has been reviewed on an annual basis. The HSP Committee has decided it is outdated; however, it has been retained for historical and/or educational purposes. These guidelines should be used with caution for clinical decision-making purposes. |
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