Chest-2008-Hirsh-71S-109S
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DOI 10.1378/chest.08-0693 2008;133;71S-109SChest Holger J. SchünemannJack Hirsh, Gordon Guyatt, Gregory W. Albers, Robert Harrington and *Executive Summary
http://www.chestjournal.org/content/133/6_suppl/71S.full.htmland services can be found online on the World Wide Web at: The online version of this article, along with updated information
) ISSN:0012-3692http://www.chestjournal.org/site/misc/reprints.xhtml(of the copyright holder.may be reproduced or distributed without the prior written permission Northbrook IL 60062. All rights reserved. No part of this article or PDFby the American College of Chest Physicians, 3300 Dundee Road, 2007Physicians. It has been published monthly since 1935. Copyright CHEST is the official journal of the American College of Chest
Copyright © 2008 American College of Chest Physicians on June 3, 2009www.chestjournal.orgDownloaded from
ExecutiveSummary*
AmericanCollegeofChestPhysicians
Evidence-BasedClinicalPracticeGuidelines
(8thEdition)
JackHirsh,MD,FCCP,Chair;GordonGuyatt,MD,FCCP;
GregoryW.Albers,MD;RobertHarrington,MD,FCCP;
andHolgerJ.Schu¨nemann,MD,PhD,FCCP
(CHEST2008;133:71S–105S)
Keywords:guidelines;recommendations
Abbreviations:ACCPϭAmericanCollegeofChestPhysicians;ACSϭacutecorronarysyndromes;AFϭatrialfibrillation;AISϭarterialischemicstroke;APTTϭactivatedpartialthrom-boplastintime;CABGϭcoronaryarterybypassgrafting;CrClϭcreatinineclearance;CSVTϭcerebralsinovenousthrombosis;CTPHϭchronicthromboembolicpulmonaryhy-pertension;CVLϭcentralvenousline;DVTϭdeepveinthrom-bosis;GCSϭgraduatedcompressionstockings;GPϭglyco-protein;HITϭheparin-inducedthrombocytopenia;IPCϭintermittentpneumaticcompression;INRϭinternationalnor-malizedratio;LDUHϭlow-doseunfractionatedheparin;LMWHϭlow-molecular-weightheparin;MVPϭmitralvalveprolapse;NSTEϭnon–ST-segmentelevation;PCIϭpercutanouscoronaryintervention;PEϭpulmonaryembolism;PMBVϭpercutaneousmitralvalveballoonvalvotomy;PTSϭpostthromboticsyndrome;PVTϭprostheticvalvethrombosis;SCϭsubcutaneous;SCIϭspinalcordinjury;TEEϭtransesophagealechocardiogra-phy;tPAϭtissueplasminogenactivator;UACϭumbilicalarterycatheter;UFHϭunfractionatedheparin;VFPϭvenousfootpump;VKAϭvitaminKantagonist;VTEϭvenousthromboembolism
Thisexecutivesummaryaccompaniesthepublica-
tionof8theditionof“Antithromboticand
ThrombolyticTherapy:AmericanCollegeofChest
Physicians(ACCP)Evidence-BasedClinicalPractice
Guidelines.”Theseguidelinesprovideanextensivecriticalreviewoftheliteraturerelatedtomanage-
mentofthromboembolicdisorders.
Ineachchapter,theclinicalquestionunderconsid-
eration,theclinicaltrialsevaluatingtheevidence,and
therecommendationsarelinkedbyanumbering
schemecommontothesethreeitems.Therecommen-
dationsareincludedatthebeginningofthechapters
andarepresentedinthisexecutivesummary.
Thegradingsysteminthe8theditionoftheACCP
guidelinesreflectsthesystemadoptedforallACCP
guidelines,andissimilartotheGRADEsystem,which
isbeingwidelyadoptedbymanyguidelinegroups.The
strengthofanyrecommendationdependsontwofac-
tors:thetrade-offbetweenbenefits,risks,burden,and
cost,andthelevelofconfidenceinestimatesofthose
benefitsandrisks.Ifbenefitsdoordonotoutweigh
risks,burden,andcosts,astrongrecommendationis
designatedasGrade1.Ifthereislesscertaintyabout
themagnitudeofthebenefitsandrisks,burden,and
costs,aweakerGrade2recommendationismade.
Supportfortheserecommendationsmaycomefrom
high-quality,moderate-quality,orlow-qualityevidence,
labeled,respectively,A,B,andC.Thephrase“we
recommend”isusedforstrongrecommendations
(Grade1A,1B,1C)and“wesuggest”forweaker
recommendations(2A,2B,2C).Thefullsetofrecom-
mendationsfollows.
ParenteralAnticoagulants
2.2.3MonitoringAntithromboticEffect
2.2.3.Inpatientstreatedwithlow-molecular-
weightheparin(LMWH),werecommend
againstroutinecoagulationmonitoring(Grade
1C).Inpregnantwomentreatedwiththerapeu-
ticdosesofLMWH,werecommendmonitoring
ofanti-Xalevels(Grade1C).*FromHamiltonCivicHospitals(Dr.Hirsh),HendersonResearchCentre,Hamilton,ON,Canada;McMasterUniversityMedicalCentre(Dr.Guyatt),Hamilton,ON,Canada;StanfordUniversityMedicalCenter(Dr.Albers),StanfordStrokeCenter,PaloAlto,CA;DukeClinicalResearchInstitute(Dr.Harrington),DukeUniversityMedicalCenter,Durham,NC;andDepartmentofClinicalEpide-miology/INFORMA(Dr.Schu¨nemann),IstitutoReginaElena,Rome,Italy.ManuscriptacceptedDecember20,2007.ReproductionofthisarticleisprohibitedwithoutwrittenpermissionfromtheAmericanCollegeofChestPhysicians(www.chestjournal.org/misc/reprints.shtml).Correspondenceto:GordonH.Guyatt,MD,FCCP,McMasterUniversityMedicalCentre,2C12,1200MainStW,Hamilton,ON,L8N3Z5,Canada;e-mail:guyatt@mcmaster.caDOI:10.1378/chest.08-0693CHEST
Supplement
ANTITHROMBOTICANDTHROMBOLYTICTHERAPY8THED:ACCPGUIDELINES
