title: 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 guidelines.
abstract: 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.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: ignacio.neumann@gmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Neumann
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Department of Orthopaedic, School Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Macarena
authors.initials: M
authors.lastname: Valdes
authors.affiliation: Comisión de Medicina Preventiva e Invalidez, Ministerio de Salud, Santiago, Chile.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bravo
authors.affiliation: School of Nursing, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Silvana
authors.initials: S
authors.lastname: Araos
authors.affiliation: Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY.
authors.forename: Victor
authors.initials: V
authors.lastname: Kairouz
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Holger
authors.initials: H
authors.lastname: Schünemann
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D016265:Conflict of Interest; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D008511:Medicine; D011057:Politics; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013896:Thoracic Diseases; D014481:United States
chemical_list: D005343:Fibrinolytic Agents