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A systematic critical appraisal of clinical practice guidelines of antithrombotic agents in gastrointestinal
Denisse Camille Dayto1, Wojciech Blonski2,3, Tea Reljic4
1HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida, USA.
Insights
This study assessed clinical practice guidelines (CPGs) for managing antithrombotic agents during gastrointestinal endoscopy. While clarity and scope were high, applicability and rigor need improvement in these important CPGs.
Area of Science:
- Gastroenterology
- Clinical Practice Guidelines
- Pharmacology
Background:
- Systematic appraisal of clinical practice guidelines (CPGs) for antithrombotic agent management in gastrointestinal (GI) endoscopy is lacking.
- Recent CPGs (2016-2022) addressing periendoscopic antithrombotic management require quality evaluation.
Purpose of the Study:
- To evaluate the methodological quality of CPGs for managing antithrombotic agents in patients undergoing GI endoscopy.
- Focus on guidelines published within the last six years.
Main Methods:
- Systematic literature search of PubMed and Embase (January 2016 - April 2022).
- Independent quality assessment of eligible CPGs using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument.
- Six reviewers assessed domain scores, with >60% considered sufficient and >80% considered good quality.
Main Results:
- Seven CPGs from Asia, Europe, and North America were appraised.
- High scores for Scope and Purpose (93%), Clarity of Presentation (100%), and Editorial Independence (93%).
- Lower scores for Applicability (32%) and Rigor of Development (79%) indicate areas for improvement.
Conclusions:
- Methodological quality of CPGs for periendoscopic antithrombotic management is variable across domains.
- Significant opportunities exist to enhance the methodological rigor and practical applicability of these guidelines.
Background And Aim:
The quality of clinical practice guidelines (CPGs) for the management of antithrombotic agents in patients undergoing gastrointestinal (GI) endoscopy has not been systematically appraised. The goal of this study was to evaluate the methodological quality of CPGs for the management of antithrombotic agents in periendoscopic period published within last 6 years.
Methods:
A systematic search of PubMed and Embase databases was performed to identify eligible CPGs published between January 1, 2016, and April 14, 2022, addressing the management of antithrombotic agents in the periendoscopic period. The quality of the CPG was independently assessed by six reviewers using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Domain scores were considered of sufficient quality when > 60% and of good quality when > 80%.
Results:
The search yielded 343 citations, of which seven CPGs published by the gastroenterology associations in Asia (n = 3), Europe (n = 2), and North America (n = 2) were included for the critical appraisal. The overall median score for the AGREE II domains was 93% (interquartile range [IQR] 11%) for scope and purpose, 79% (IQR 61%) for stakeholder involvement, 79% (IQR 36%) for rigor of development, 100% (IQR 14%) for clarity of presentation, 32% (IQR 36%) for applicability, 93% (IQR 29%) for editorial independence, and 86% (IQR 29%) for overall assessment.
Conclusions:
The findings show that the overall methodological quality of the CPGs for the management of antithrombotic agents in the periendoscopic period varies across the domains. There is significant scope for improvement in the methodological rigor and applicability of CPGs.
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