Applying new strategies for the national adaptation, updating, and dissemination of trustworthy guidelines: results from the Norwegian adaptation of the Antithrombotic Therapy and the Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

BACKGROUND The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. We describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination. METHODS A Norwegian guideline panel of 46 experts completed a structured and systematic adaptation process, updated the recommendations based on new evidence, and rewrote the recommendations in an electronic multilayered presentation format. We published the adapted guideline using the web-based Making GRADE the Irresistible Choice Guideline Authoring and Publication Platform. RESULTS We applied a novel presentation format to 333 recommendations from 11 of the 15 management chapters in AT9 and condensed and restructured them into 249 recommendations in a multilayered format. We added additional relevant information, such as 29 best-practice statements about new oral anticoagulants and practical information sections for 121 recommendations. Common reasons for modifications included feasibility of the recommendations in a national context, disagreement with applied baseline risk estimates, and reevaluation of the balance between the benefits and harms of interventions in relation to assumed typical patient preferences and values. The adapted guideline was published and disseminated online in November 2013. CONCLUSIONS New strategies for adapting, updating, and disseminating trustworthy guidelines proved feasible and will provide Norwegian health-care professionals and patients with up-to-date guidance tailored to national circumstances.

[1]  A. Rutjes,et al.  Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy. , 2016, The Cochrane database of systematic reviews.

[2]  Mohammad Hassan Murad,et al.  Development of a novel, multilayered presentation format for clinical practice guidelines. , 2015, Chest.

[3]  Thomas Agoritsas,et al.  Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process. , 2014, Chest.

[4]  David A. Cook,et al.  Features of Effective Medical Knowledge Resources to Support Point of Care Learning: A Focus Group Study , 2013, PloS one.

[5]  D. Giannarelli,et al.  Prevention of VTE in orthopedic surgery patients , 2013 .

[6]  Thomas Agoritsas,et al.  Creating clinical practice guidelines we can trust, use, and share: a new era is imminent. , 2013, Chest.

[7]  Richard Baker,et al.  A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice , 2013, Implementation Science.

[8]  A. Mebazaa,et al.  Rivaroxaban for thromboprophylaxis in acutely ill medical patients. , 2013, The New England journal of medicine.

[9]  Sarah E. Rosenbaum,et al.  Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results , 2013, Implementation Science.

[10]  A. Khorana,et al.  International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer , 2013, Journal of thrombosis and haemostasis : JTH.

[11]  John W. Williams,et al.  Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review. , 2012, Annals of internal medicine.

[12]  J. Douketis,et al.  Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis: A Systematic Review , 2012 .

[13]  J. Grimshaw,et al.  Knowledge translation of research findings , 2012, Implementation Science.

[14]  Shunichi Homma,et al.  Warfarin and aspirin in patients with heart failure and sinus rhythm. , 2012, The New England journal of medicine.

[15]  G. Guyatt,et al.  Oral Direct Factor Xa Inhibitors Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Patients Undergoing Total Hip or Knee Replacement , 2012, Annals of Internal Medicine.

[16]  N. Kløw,et al.  Long-term Outcome After Additional Catheter-Directed Thrombolysis Versus Standard Treatment for Acute Iliofemoral Deep Vein Thrombosis (the CaVen T Study): A Randomised Controlled Trial , 2012 .

[17]  D. Veenstra,et al.  VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. , 2012, Chest.

[18]  Paolo Prandoni,et al.  Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. , 2012, Chest.

[19]  Gordon H Guyatt,et al.  Executive Summary Antithrombotic Therapy and Prevention of Thrombosis , 9 th ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines , 2012 .

[20]  Elie A Akl,et al.  Prevention of VTE in Nonsurgical Patients Antithrombotic Therapy and Prevention of Thrombosis , 9 th ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines , 2013 .

[21]  L. Sandvik,et al.  Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial , 2012, The Lancet.

[22]  M. Di Nisio,et al.  Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy. , 2012, The Cochrane database of systematic reviews.

[23]  S. Goldhaber,et al.  Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. , 2011, The New England journal of medicine.

[24]  H. Sørensen,et al.  Venous thromboembolism in patients having knee replacement and receiving thromboprophylaxis: a Danish population-based follow-up study. , 2011, The Journal of bone and joint surgery. American volume.

[25]  Louise Lemieux-Charles,et al.  How can we improve guideline use? A conceptual framework of implementability , 2011, Implementation science : IS.

[26]  H. Kehlet,et al.  Low risk of thromboembolic complications after fast-track hip and knee arthroplasty , 2010, Acta orthopaedica.

[27]  G. Guyatt,et al.  Going from evidence to recommendations , 2008, BMJ : British Medical Journal.

[28]  Gordon H Guyatt,et al.  GrADe : what is “ quality of evidence ” and why is it important to clinicians ? rATING quALITY of evIDeNCe AND STreNGTH of reCommeNDATIoNS , 2022 .

[29]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[30]  J. Douketis,et al.  Meta-analysis: Anticoagulant Prophylaxis to Prevent Symptomatic Venous Thromboembolism in Hospitalized Medical Patients , 2007, Annals of Internal Medicine.

[31]  Richard N. Shiffman,et al.  Bmc Medical Informatics and Decision Making the Guideline Implementability Appraisal (glia): Development of an Instrument to Identify Obstacles to Guideline Implementation , 2022 .

[32]  R. Yusen,et al.  Subcutaneous Enoxaparin Once or Twice Daily Compared with Intravenous Unfractionated Heparin for Treatment of Venous Thromboembolic Disease , 2001, Annals of Internal Medicine.

[33]  R. Collins,et al.  Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. , 1988, The New England journal of medicine.