Perioperative management of apixaban in patients with advanced CKD undergoing a planned invasive procedure
Notice bibliographique
Résumé
Oral anticoagulation therapy is used for both the prevention of stroke in atrial fibrillation (AF) and the treatment of venous thromboembolism (VTE).AF and VTE are both common among patients with chronic kidney disease (CKD).1,2 Approximately 15% to 20% of patients on dialysis have AF. 3 CKD is consistently identified as a risk factor for bleeding, including anticoagulation-associated bleeding.4 As a result, the prevention of AF/VTE-related morbidity in patients with CKD is difficult.There is growing interest in using apixaban in patients with kidney dysfunction due to its convenience and low dependence on renal elimination.Limited pharmacokinetic data have shown that patients with advanced CKD experience modest increases in apixaban area under the curve (AUC) plasma concentration-time values compared with patients with normal kidney function after a single dose.5 Dialysis has little effect on apixaban levels.6 Up to 15% to 20% of patients on anticoagulation therapy require perioperative interruption of their therapy every year.7 Interruption of apixaban in patients with advanced CKD can be challenging due to altered pharmacokinetics and delayed clearance.8 There is no data to guide clinicians facing this situation.The perioperative management of direct oral anticoagulants (DOACs) in patients with advanced CKD was identified as an important area for future research by the American College of Chest Physicians.7 We conducted a single-center, retrospective cohort study of consecutive apixaban-treated patients with advanced CKD who underwent a planned invasive procedure between June 2019 and March 2023, with the goal of describing the perioperative management of apixaban in this population and to determine the postoperative risks of major bleeding (MB), thromboembolism, and death.The study was approved by the Ottawa Health Science Network Research Ethics Board and was conducted according to the Declaration of Helsinki.Patients were included if they were 1) anticoagulated with apixaban for any indication and at any dose, and 2) had advanced CKD (CrCl ≤ 30 mL/min based on the Cockcroft-Gault formula) or were undergoing dialysis for ≥3 months before the perioperative anticoagulation encounter.Patients with acute kidney injury were excluded.9 A procedure was defined as "planned" when occurring ≥72 hours from the decision to proceed with an invasive intervention.Perioperative management of apixaban was at the discretion of the treating physician.Procedural bleed risk stratification was retrospectively assigned according to binary risk strata (low/moderate-vs high-bleed-risk), as recommended by the International Society on Thrombosis and Haemostasis (ISTH).10 We recorded data on demographics, apixaban indication/dosing, renal function, procedure details, and perioperative management.Adjudicated clinical outcomes (G.H. and J.R.S.) included the 30-day postoperative risks of arterial thromboembolism (ATE), VTE, MB, clinically relevant non-major bleeding (CRNMB) and all-cause mortality.Surgical MB and CRNMB were defined using ISTH criteria [11][12][13] ; thrombotic outcome definitions are outlined in supplemental Table 1.Continuous variables are summarized using median and interquartile
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 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 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 ».