Should we follow the 9th ACCP guidelines for VTE prevention in surgical patients? ☆ Juan I. Arcelus ⁎, Jesus M. Villar, Nuria Muñoz Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain abstract The 9th edition of the American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy and pre- vention, includes relevant changes compared to previous versions. In the 9th ACCP, leadership of most chapters was given to methodologists who were familiar with the GRADE methodology. All topic panelists underwent a selection process paying particular attention to their financial and intellectual conflicts of interests. In the 9th ACCP guide- lines, evidence has been explicitly presented in many evidence profiles and summary of evidence tables. In order to get a more balanced trade-off between desirable and undesirable effects of the alternative preven- tion and therapeutic interventions, there has been an increased emphasis on clinically relevant events, as op- posed to previous surrogate asymptomatic outcomes. In addition, there has been a systematic review and survey on patient values and preferences for thrombotic and bleeding outcomes. As a result of the above changes, the strength of most recommendations has been downgraded compared to previous editions. The main changes regarding prevention on nonorthopedic surgical patients include the adoption of two risk assessment models. The only recommendation that has been upgraded is to extend prophylaxis with low mo- lecular weight heparins (LMWH) for four weeks after abdominal or pelvic cancer surgery. A controversial modification in orthopedic patients is recommendation in favor of the use of aspirin after hip or knee arthroplasty. New oral anticoagulants are recommended, but LMWH are suggested as the preferred option. Extending pharmacological prophylaxis for up to 35 days rather than 10–14 days is now suggested for pa- tients undergoing major orthopedic surgery. © 2012 Elsevier Ltd. All rights reserved. Introduction In February 2012, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines on antithrombotic therapy and prevention were published in the journal Chest. The previous 8th edition was published in 2008 in a large print version with more than 900 pages, providing a narrative evidence sum- mary with a limited number of evidence profiles summarizing the evi- dence. For the 9th iteration of the ACCP guidelines, the Executive Committee has made an effort to reduce the extension of the document. Accordingly, a decision was made to publish a reduced very focused print version in the journal Chest with only three articles covering major inno- vations, methodology for the development of the guidelines, and an exec- utive summary with all recommendations and grading for each article. The full version of the 9th ACCP guidelines is now available online in Chest website (http://chestjournal.chestpubs.org/content/141/2_suppl), where the 21 articles can be accessed. There are also online data supplements for the articles that include recommendations, with many evidence profiles that summarize the quality of the evidence. Major innovations in the 9th guidelines A major change in the 9th edition of the ACCP guidelines involves the composition and selection of topic panel members. In previous edi- tions, most panel members were thrombosis experts, some of them with relevant financial and intellectual conflicts of interests [1]. For the 9th edition, the Executive Committee gave primary leadership and responsibility for each article to a methodologist who was usually a practicing physician with previous experience on guideline develop- ment, but not a thrombosis expert. These topic editors were also famil- iar with the methods developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group [2]. Other panel members, including deputy-editors had relevant clini- cal or research record in the field of thrombosis, and some of them had participated in previous ACCP guidelines. All nominees were approved after reviewing their curricula vitae and conflict of interest disclosures. Of the 150 candidates to become panelists, 137 were ap- proved, 18 were approved with management of conflict of interest (who could engage in the discussions and draft evidence summaries but were excluded from the final decisions regarding quality of evi- dence and strength of recommendations), and 13 were disapproved. Thrombosis Research 130 (2012) S4–S6 ☆ Presented to the Scientific Symposia on October 7th, 2012, during the 22nd Inter- national Congress on Thrombosis held in Nice (France) from October 6th to 9th, 2012. ⁎ Corresponding author at: Calle Madrid 119A, 18193 Monachil (Granada), Spain. Tel.: +34 678640630; fax: +34 958244050. E-mail address: j.arcelus@telefonica.net (J.I. Arcelus). 0049-3848/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.thromres.2012.08.260 Contents lists available at SciVerse ScienceDirect Thrombosis Research journal homepage: www.elsevier.com/locate/thromres