COMPARISON OF A NOMOGRAMAND PHYSICIAN-ADJUSTED DOSAGE OF WARFARIN FOR PROPHYLAXIS AGAINST DEEP-VEIN THROMBOSIS AFTER ARTHROPLASTY
Notice bibliographique
Résumé
BACKGROUND: Warfarin is an effective agent for prophylaxis against deep-vein thrombosis following total hip or knee arthroplasty. However, management with warfarin in the postoperative setting is problematic because of the need for anticoagulant monitoring. We developed a nomogram for the dosing of warfarin that was specific for joint arthroplasty. The objective of this study was to compare the performance of this nomogram with that of physician-adjusted dosing of warfarin for patients undergoing total hip or knee arthroplasty. METHODS: The study involved two cohort trials. The historical control group consisted of 1024 patients who underwent total hip or knee arthroplasty during the course of a clinical trial (the Post-Arthroplasty Screening Study [PASS]) in which all warfarin dose adjustments were made by two hematologists. The first dose of warfarin was given on the evening of the surgery, and the warfarin dose was adjusted daily on the basis of the international normalized ratio and was discontinued at the time of discharge from the hospital. In the PASS study, the dosage of warfarin was designed to prolong the international normalized ratio to 1.7 by postoperative day 4 and to maintain it between 1.8 and 2.5 until discharge from the hospital. Subsequently, a warfarin nomogram was developed on the basis of the dose adjustments used in the PASS study, and it was used prospectively to manage a cohort of 729 patients undergoing total hip or knee arthroplasty. In the nomogram cohort, the initial dose of warfarin was given on the evening of the surgery. Both cohorts were followed for twelve weeks after the surgery to determine if any venous thromboembolic complications had developed. RESULTS: The nomogram cohort and the control cohort had similar daily doses of warfarin (mean, 3.2 versus 3.3 mg) and levels of international normalized ratio on postoperative day 4 (mean, 1.9 versus 1.9) (p > 0.2). The average number of days to achieve an international normalized ratio of >1.7 was 4.0 for the nomogram cohort compared with 4.3 for the control cohort (p = 0.01). The percentage of days that the international normalized ratio was between 1.8 and 2.5 was 61% for the nomogram cohort and 58% for the control cohort (p < 0.01), and the percentage of days that the international normalized ratio was >3.0 was only 6.5% for the nomogram cohort and 6.0% for the control cohort (p > 0.2). Eighty-two percent of the patients managed with the nomogram achieved an international normalized ratio of >1.7 by the time of discharge from the hospital compared with 92% in the control cohort (p = 0.01). In the three-month follow-up period, a deep-vein thrombosis or a nonfatal pulmonary embolism developed in nineteen patients (2.6%; 95% confidence interval, 1.6% to 4.0%) in the nomogram cohort compared with fourteen patients (1.4%; 95% confidence interval, 0.7% to 2.3%) in the control cohort. No major bleeding event or fatal pulmonary embolism was observed in the patients managed with use of the nomogram. CONCLUSION: This study demonstrated that the administration of warfarin during hospitalization with use of a nomogram designed for the prevention of deep-vein thrombosis following total hip or knee arthroplasty provided effective and safe prophylaxis that was comparable with that provided by physician-adjusted dosing of warfarin.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,019 | 0,058 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».