Management of Cerebral Vein Thrombosis in a Canadian Tertiary Hospital
Notice bibliographique
Résumé
Abstract Introduction: Cerebral vein thrombosis (CVT) is an uncommon cause of stroke and is more likely to affect young adults and children. Women have a three-fold increased risk compared to men, owing to gender specific factors such as oral contraceptive use (OCP), pregnancy, and hormone replacement therapies. The presenting symptoms of CVT are non-specific and include headache, seizure, focal neurological deficits, or coma as the most severe presentation. The rarity and variable symptoms of the disease leads to delayed diagnosis and implementation of treatment. With improved imaging techniques and increased awareness in recent years, CVT is now more often recognized. Aim: To evaluate patients admitted to The Ottawa Hospital with diagnosis of CVT including demographics, symptoms at presentation, risk factors for CVT, management practices during hospital stay, and discharge disposition. Where available, 12-month follow-up information is provided. Methods: A retrospective chart review of patients admitted to The Ottawa Hospital with diagnosis of CVT between January 2010 - December 2017. Patients were identified using ICD-10 codes from the Ottawa Hospital Data Warehouse. Results: 123 patients were identified in the Data Warehouse and manual chart review confirmed 61 patients diagnosed with CVT. The mean age was 46 years, and 44 (72%) were women. The average hospital stay was 10 days (range 1-66 days) and 25 patients (40%) were admitted to a monitored setting during hospitalization. Only 4 patients had prior history of venous thrombosis. 38 patients (62%) had provoking risk factors for CVT including: surgery (n=6); cancer (5); pregnancy/peripartum (5); oral contraceptive use (21); the remaining 23 patients were unprovoked CVT events. Imaging findings at diagnosis showed 17 patients (28%) had intracranial hemorrhage such as subarachnoid hemorrhage and intraparenchymal bleeding; 17 (28%) had infarction; and 13 (21%) had cerebral edema. All patients received parenteral anticoagulation at time of CVT diagnosis: 54 (89%) with IV unfractionated heparin and the remainder received low molecular weight heparins. One patient received catheter directed thrombolysis, one patient had mechanical embolectomy, two patients underwent decompressive craniectomy, and one patient had both catheter directed thrombolysis and decompression surgery. Four patients died during hospital stay, one directly related to CVT and another due to anticoagulation associated intracranial hemorrhage. More than half of patients were started on warfarin at the time of hospital discharge and no patients were discharged on direct oral anticoagulants (DOACs). 48 patients (79%) were discharged home, 7 (12%) were discharged to rehabilitation programs, and 1 patient (2%) required transfer to nursing home facility. During 12-month follow-up 45 patients (74%) had been transitioned to warfarin and 3 (5%) were on DOACs. Summary: In this cohort of patients admitted with CVT to a large Canadian academic hospital, many were young women and were related to hormonal therapies or peripartum state. All patients received parenteral anticoagulation in hospital and warfarin was the most common oral anticoagulant prescribed. Patients with severe CVT required invasive intervention, with two deaths attributed to CVT or complications from anticoagulation. Most patients returned home within 12-months of discharge from hospital. Disclosures Castellucci: LEO Pharma: Honoraria; Aspen: Honoraria; BI: Honoraria; Sanofi: Honoraria; Bayer: Honoraria; BMS/Pfizer: Honoraria.
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 | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,005 | 0,001 |
| Communication savante | 0,002 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 ».