Management of Anticoagulation in Patients Who Require Invasive Procedures
Bibliographic record
Abstract
When orally anticoagulated patients need to have surgery, the goals of management are to minimize the risks of thromboembolism and of bleeding from the invasive procedure. Some invasive procedures can be performed while patients are fully or partially anticoagulated because bleeding is rare and/or easily controlled. When it is necessary to reverse oral anticoagulant therapy it should be interrupted for as short a time as possible, usually 4 or 5 days. Intravenous unfractionated heparin or therapeutic-dose subcutaneous low-molecular-weight heparin (LMWH) can be given as "bridging therapy" to reduce the risk of thromboembolism while oral anticoagulation is interrupted. However, the risks and benefits of bridging therapy are uncertain. Bridging therapy, particularly with LMWH, may not be very effective at preventing embolism in patients with atrial fibrillation or mechanical heart valves, and it may be associated with bleeding. My preference is to minimize the time that patients are off oral anticoagulant therapy, generally restarting warfarin the day of surgery; reserve bridging therapy for those at highest risk of thromboembolism; and to use "prophylactic" rather than "therapeutic" doses of heparin after major surgery. As major surgery markedly increases the risk of venous thromboembolism, postoperative bridging therapy should be considered for patients without an inferior vena caval filter that have had proximal deep vein thrombosis or pulmonary embolism during the previous month.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".