The score settles it? maybe not: Navigating postpartum VTE prophylaxis
Notice bibliographique
Résumé
Abstract Background: The risk of venous thromboembolism (VTE) increases during pregnancy and continues to rise throughout pregnancy with maximum risk in the postpartum period. The guidelines that stratify patients into VTE risk categories are conflicting. Aims: (1) Evaluate the incidence of postpartum VTE (VTE within 3 months of delivery) over 1 year. (2) Determine the number of patients that would have received VTE prophylaxis based on different society recommendations. (3) Determine the number of patients with VTE that would possibly been prevented with different society recommendations. Methods: Characteristics of 3190 patients who underwent delivery at our medical center were investigated for incidence and risk factors for VTE. Data was collected using the International Classification of Diseases codes and by chart review. Descriptive statistics were calculated. Results: The incidence of postpartum VTE in our patient cohort (n=3190) was 0.25% (8/3190). Most patients were aged ≥30 (66.6%), white (61%) and had BMI >30 (61.1%). The number of patients who had previous history of cancer, lupus, inflammatory bowel disease and sickle cell disease were 77 (2.4%), 12 (0.4%), 25 (0.8%), and 2 (0.1%), respectively. Sixteen (0.5%) patients had a history of provoked VTE, and 76 (2.4%) patients had a family history of VTE. The proportion of patients who had cesarean delivery, postpartum hemorrhage, pre-eclampsia, and multiple gestation pregnancy were 571 (17.9%), 340 (10.7%), 295 (9.2%), and 40 (1.3%), respectively. 46 (1.4%) patients had prolonged hospitalization of >3 days, who were deemed to have decreased mobility, which is an important risk factor for VTE. Mechanical prophylaxis was used postpartum in 465 patients (14.4%), low molecular weight heparin in 55 patients (1.7%), and other anticoagulation in 20 patients (0.6%). Two of the patients with a VTE event within 90 days postpartum received prophylaxis in our cohort. The percentage of patients who would have received pharmacologic VTE prophylaxis based on Royal College of Obstetricians and Gynecologists (RCOG) risk factors criteria, Society of Obstetricians and Gynaecologists of Canada (SOGC), and ’Eubanks’ risk scoring criteria was 61.3% (n=1954), 33.8% (n=1077), and 15% (n=513), respectively. RCOG predicted 7 of the 8 VTE events compared to only 2 of the VTE events predicted by Eubanks. Sensitivity of RCOG was high at 87.5% whereas specificity of Eubanks was high at 0.84. SOGC predicted 4 of the VTE events with a specificity of 0.67 and sensitivity of 0.50. Conclusion: The number of postpartum patients recommended to receive peripartum anticoagulation varies widely depending on the risk scoring tool employed. Optimized risk stratification for peripartum VTE prophylaxis is needed.
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 | 0,007 | 0,040 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
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 ».