Risk of Venous Thromboembolism or Hemorrhage Among Individuals with Chronic Kidney Disease Taking a Direct Oral Anticoagulant Compared to Low-Molecular-Weight Heparin after a Hip or Knee Arthroplasty
Notice bibliographique
Résumé
Background: Individuals with chronic kidney disease (CKD) are at exceptionally high risk of both thrombosis and bleeding events. Limited comparative effectiveness evidence exists regarding the optimal choice of thromboprophylaxis in those with CKD. We set out to compare the safety and effectiveness of direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) among older individuals with CKD following hip or knee arthroplasty. Objective: To assess the 90-day risk of a venous thromboembolism (VTE) or hemorrhage with DOAC use compared to LWMH after hip or knee arthroplasty among older individuals with CKD. Methods: A population-based, retrospective cohort study was conducted among adults of age ≥ 66 with CKD undergoing hip or knee arthroplasty who had filled an outpatient DOAC prescription (apixaban, rivaroxaban, dabigatran, edoxaban) after surgery compared to LMWH (enoxaparin, dalteparin, tinzaparin) between January 1, 2010 and December 31, 2020 in Ontario, Canada. CKD was defined by at least one estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 within 2 years or the presence of chronic dialysis within 5 years. Index was the date of first filling of the outpatient anticoagulant prescription after hip or knee arthroplasty. The primary effectiveness outcome was VTE and the primary safety outcome was any hemorrhage identified by validated algorithms using relevant diagnosis and billing codes. Patients were followed until 90 days after index, end of Ontario insurance, death, or the end of follow-up period on March 31, 2021. Overlap weighted cause-specific Cox proportional hazard models were used to examine the association of the 90-day risk of a VTE and/or a hemorrhage event accounting death as a competing risk. In additional analyses, we examined a more stringent VTE defining algorithm (diagnostic codes plus procedure codes within 7 days), different eGFR cut-offs, limiting to the most commonly used DOAC and LWMH (rivaroxaban vs. enoxaparin), and a shorter (30-day) follow up period. Results: A total of 27,645 patients were prescribed DOAC or LMWH after arthroplasty (66.7% female, mean age 76, DOAC: 22,943, LMWH: 4,702, mean eGFR 51.6 mL/min, 17.7% with eGFR < 45 mL/min). DOAC users had higher eGFRs, less comorbidity, had surgeries in more recent years, were more likely to be treated in community hospitals, and with shorter time from surgery to index compared to LMWH users (Table 1). After accounting for multiple covariates, the use of DOAC, compared to LMWH, was associated with less VTE events (DOAC: 341/22,943 [1.5%] vs LMWH: 97/4,702 [2.1%], weighted hazard ratio [wHR] 0.75, 95% confidence interval [CI] 0.59-0.94) and more hemorrhage events (DOAC: 290/22,943 [1.3%] vs LMWH: 45/4,702 [1.0%], wHR 1.44, 95% CI 1.04-1.99) (Table 2)]. The findings were consistent in all additional analyses (Table 2). Conclusions: Among older adults with CKD, DOAC use was associated with lower VTE and higher hemorrhage risk compared to LMWH following knee or hip arthroplasty. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
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 | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| 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 ».