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Original Research: Education, Research, and Quality Improvement |

Low Anonymous Voting Compliance With the Novel Policy for Managing Conflicts of Interest Implemented in the 9th Version of the American College of Chest Physicians Antithrombotic GuidelinesCompliance With Policy for Conflicts of Interest

Ignacio Neumann, MD; Elie A. Akl, MD, PhD, MPH; Macarena Valdes, MT; Stephanie Bravo, MD; Silvana Araos, RN; Victor Kairouz, MD; Holger Schünemann, MD, PhD; Gordon H. Guyatt, MD, FCCP
Author and Funding Information

From the Department of Clinical Epidemiology and Biostatistics (Drs Neumann, Akl, Schünemann, and Guyatt), McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, School of Medicine (Dr Neumann), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Internal Medicine (Dr Akl), American University of Beirut, Beirut, Lebanon; Department of Medicine (Drs Akl and Kairouz), University at Buffalo, The State University of New York, Buffalo, NY; Department of Orthopaedic (Ms Valdes), School Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Comisión de Medicina Preventiva e Invalidez (Dr Bravo), Ministerio de Salud, Santiago, Chile; and School of Nursing (Ms Araos), Universidad del Desarrollo, Santiago, Chile.

Correspondence to: Ignacio Neumann, MD, Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C12, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada; e-mail: ignacio.neumann@gmail.com


For editorial comment see page 1087

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1111-1116. doi:10.1378/chest.13-0169
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Background:  The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a strategy to limit the impact of conflict of interest (COI) on recommendations. This policy excluded conflicted panelists from voting on recommendations with which they had conflicts. The objective of the study is to explore the compliance of the attendees of the AT9 final conference.

Methods:  We conducted a survey and reviewed public declarations of COI of all the final AT9 conference attendees. For each of the controversies on which voting occurred (nine of 628 total recommendations), we estimated the compliance with COI policy as the proportion of attendees who recused themselves from voting on controversies for which they were conflicted. To evaluate the potential effect of noncompliance, we assumed that every vote cast by an ineligible conference attendee was cast in direction of the majority vote.

Results:  Sixty-three panelists voted in at least one controversy at the final conference; the percentage of conflicted panelists varied from 6% to 39% for eight controversies. The compliance with the COI policy was 14 of 14 (100%) for one controversy, and varied from one of 19 (5%) to one of three (33%) in the remaining seven. In two of the eight controversies (“Compression device plus aspirin vs low-molecular-weight heparin in tromboprophylaxis in orthopedic surgery” and “Low-molecular-weight heparin vs vitamin K antagonists for treatment”), the low compliance may have affected the final recommendations.

Conclusions:  The low compliance raises concerns about implementation of COI restrictions in the context of anonymous voting.


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