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Evidence Underlying the American College of Chest Physicians (ACCP) Clinical Practice Guidelines for the Prevention, Diagnosis, and Management of Venous Thromboembolism FREE TO VIEW

Sarthi Shah; Abdur Rahman Khan; Sobia Khan; Ragheb Assaly
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University of Toledo Medical Center, Toledo, OH

Chest. 2014;146(4_MeetingAbstracts):821A. doi:10.1378/chest.1995242
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The American College of Chest Physicians (ACCP) regularly establishes and publishes clinical practice guidelines for the prevention, diagnosis and management of venous thromboembolism (VTE). These practice guidelines guide physicians in providing appropriate care to patients either at risk or having thrombosis. Our objective is to evaluate the quality of evidence underlying these clinical practice recommendations.

METHODS: At the time of our review on March 31, 2014, out of a total of 20 practice guidelines issued by ACCP, 14 were pertaining to prevention, diagnosis or management of thromboses. Guidelines pertaining to antithrombotic therapy in atrial fibrillation, cerebrovascular disease and peripheral artery disease were not included in the analysis as we wanted to focus on VTE. The guidelines were graded as per the ACCP-GRADE (Grading of Recommendations Assessment, Development and Evaluation) system of ranking evidence in clinical practice guidelines. In this system, the letters A through C signify the level of evidence for or against a preventive or therapeutic measure, and numbers 1 and 2 indicate the strength of the recommendation. The number of recommendations and their distribution among strength of recommendation and quality of evidence classes were quantified. The summary of the distribution is reported as the median of the percentage of all the eligible guidelines.

RESULTS: The 9 analyzed clinical practice recommendations contained a total of 377 recommendations. Around 39% of the recommendations were supported by level B evidence (median 38.5%; IQR 23.8%-53.3%), based on evidence which may need further research, while 61% of the recommendations were based on level C evidence (median 60.9%; IQR 46.7%-76.2%) which likely need more research. The strength of recommendation was labeled as strong in around 22% while it was moderate in 72%.

CONCLUSIONS: The ACCP guidelines pertaining to VTE are primarily based on low-moderate quality evidence. Although revised guidelines are based on increased research through randomized controlled trials (RCT), a large number of recommendations still rely on observational studies, case series, or only a few RCTs.

CLINICAL IMPLICATIONS: Clinical practice guidelines can only summarize the best available evidence; in the case of VTE, there are areas which lack of adequate evidence. There is need to recognize these areas and close these knowledge gaps in the evidence base through further research and well designed studies.

DISCLOSURE: The following authors have nothing to disclose: Sarthi Shah, Abdur Rahman Khan, Sobia Khan, Ragheb Assaly

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