Background The American College of Chest Physicians (ACCP) Antithrombotic Guidelines (AT9) addressed both financial and intellectual COI, and restricted panellists from voting on recommendations on which they declared a primary conflict. The extent to which intellectual COI restricted participation beyond financial COI is uncertain.

Objective The objective is to describe financial and intellectual COI among AT9 panellists and assess their overlap.

Methods The AT9 executive committee developed definitions and categorizations of primary and secondary financial and intellectual COI. panellists reported, for each recommendation, their financial and intellectual COIs. We analysed their declarations.

Results Among 102 panellists, the average number of recommendations for which panellist declared COI was: 2.1 (SD 5.7) for secondary financial COI, 1.7 (SD 3.5) for primary financial COI, 5.0 (SD 9.9) for secondary intellectual COI, and 2.5 (SD 5.0) for primary intellectual COI. Of the 102 panellists 37 (36%) declared a primary intellectual but no primary financial COI for at least one recommendation. Among 431 recommendations, the average number of panellists per recommendation who declared COI was: 0.5 (SD 0.8) for secondary financial COI, 0.4 (SD 0.9) for primary financial COI, 1.2 (SD 1.2) for secondary intellectual COI, and 0.6 (SD 1.2) for primary intellectual COI. In 63 recommendations (23%) at least one panellist had a primary intellectual COI but no primary financial COI

Conclusion A substantial number of declarations resulted in restrictions based on intellectual COI in the absence of financial COI.