ACCP9抗栓指南更新点.pdf

What’s new in the 2012 ACCP Guidelines VTE treatment… Mark Crowther, MD McMaster University Disclosure ?? Advisory boards: Leo Pharma, Pfizer, Bayer, Boehringer Ingelheim, Alexion, CSL Behring, Takeda and Artisan Pharma ?? Educational materials for Pfizer, Octapharm and CSL Behring ?? Expert testimony for Bayer and Pfizer ?? Career Investigator award from the Heart and Stroke Foundation of Ontario ?? Leo Pharma Chair in Thromboembolism Research at McMaster University ?? Institutional funding for research projects from Boehringer Ingelheim, Octapharm, Pfizer and Leo Pharma. Introduction ?? Two types of chapters ?? Background chapters ?? Highly comprehensive introductory chapters outlining the content discussed in the recommendation chapters ?? Chapters with recommendations ?? Methodologically rigorous literature reviews, evidence grading and evidence presentation Where did all my 1A recommendations go? “Relying on the perspective of unconflicted methodologists, rigorously applying the GRADE approach, and excluding those with financial and intellectual conflict of interests from bottom-line decisions regarding the quality of evidence and strength of recommendations led to re-evaluations of previously existing evidence” Page 50S ?? Unconflicted methodologists ?? All chapters with recommendations had a methodologist on them ?? Methodologist took “responsibility” for the chapter, including ensuring the product was a free of bias as possible ?? All were methodological experts, but many had no particular expertise in thrombosis ?? Methodological skill is not content specific GRADE approach “Application of the GRADE approach requires the distinction between patient-important and surrogate outcomes. The (prior) guidelines failed to fully recognize the implications of a surrogate widely used in thrombosis prevention trials— asymptomatic, screening-detected thrombosis. Use of this surrogate creates major problems in making t