Design and created by Guideline Central in participation with the American College of Chest Physicians.
American College of Chest Physicians
Publication Date: Feb 1, 2012
Page Last Updated: May 5, 2026
| GRADE | Grade of Recommendation | Benefit vs Risk and Burdens | Methodologic Strength of Supporting Evidence | Implications | |
| S-H | Strong recommendation, high-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa. | We are very confident that the true effect lies close to that of the estimate of the effect. | Recommendation can apply to most patients in most circumstances. Further research is very unlikely to change our confidence in the estimate of effect. | |
| S-M | Strong recommendation, moderate-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa. | We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. | Recommendation can apply to most patients in most circumstances. Higher-quality research may well have an important impact on our confidence in the estimate of effect and may change the estimate. | |
| S-L | Strong recommendation, low-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa. | Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. | Recommendation can apply to most patients in many circumstances. Higher-quality research is likely to have an important impact on our confidence in the estimate of effect and may well change the estimate. | |
| S-VL | Strong recommendation, very low-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa. | We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | Recommendation can apply to most patients in many circumstances. Higher-quality research is likely to have an important impact on our confidence in the estimate of effect and may well change the estimate. | |
| W-H | Weak (conditional) recommendation, high-quality evidence | Benefits closely balanced with risks and burden. | We are very confident that the true effect lies close to that of the estimate of the effect. | The best action may differ depending on circumstances or patients’ or societal values. Further research is very unlikely to change our confidence in the estimate of effect. | |
| W-M | Weak (conditional) recommendation, moderate-quality evidence | Benefits closely balanced with risks and burden. | We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different | Best action may differ depending on circumstances or patients’ or societal values. Higher-quality research may well have an important impact on our confidence in the estimate of effect and may change the estimate. | |
| W-L | Weak (conditional) recommendation, low-quality evidence | Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced. | Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. | Other alternatives may be equally reasonable. Higher-quality research is likely to have an important impact on our confidence in the estimate of effect and may well change the estimate. | |
| W-VL | Weak (conditional) recommendation, very-low quality evidence | Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced. | We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | Other alternatives may be equally reasonable. Higher-quality research is likely to have an important impact on our confidence in the estimate of effect and may well change the estimate. | |
| Ungraded consensus-based suggestions | |||||
| U-CBS | Ungraded Consensus-Based Statement | Uncertainty because of lack of evidence but expert opinion that benefits outweigh risk and burdens or vice versa. | Insufficient evidence for a graded recommendation. | Future research may well have an important impact on our confidence in the estimate of effect and may change the estimate. | |
D011655 - Pulmonary Embolism
D020521 - Stroke
D000925 - Anticoagulants
D001281 - Atrial Fibrillation
D001281 - Atrial Fibrillation
D000925 - Anticoagulants
D020521 - Stroke
D011655 - Pulmonary Embolism
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