The American College of Chest Physicians published their first consensus conference guidelines on antithrombotic therapy in 1986 and has updated these guidelines approximately every 3 years as a supplement to the journal Chest. These guidelines are widely accepted as an authoritative source of information and considered by many to be the textbook for antithrombotic therapy. The most recent guidelines are from the 8th consensus conference, published in 2008, and this article will highlight new recommendations that have evolved since the 2004 Chest supplement. Examples from the literature that support the evolution these guidelines will focus on changes that are most germane to the majority of attendees at the 10th National Conference on Anticoagulant Therapy and members of the AC Forum. The objective of this article is to help answer ten common clinical questions frequently faced by anticoagulation management services.