A Model for Perioperative Outpatient Management of Anticoagulation in High-Risk Patients: An Evaluation of Effectiveness and Safety
Bibliographic record
Abstract
ABSTRACT Objective: To assess the effectiveness and safety of a hospitalbased perioperative outpatient program for patients at risk for thromboembolic complications who require temporary interruption of oral anticoagulants for dental, surgical, or diagnostic procedures. Methods: A prospective cohort study was performed with consecutive high-risk patients receiving long-term oral anticoagulant therapy who required surgical procedures during a 12-month study period. High-risk patients were defined as those with recent or recurrent venous thromboembolism, atrial fibrillation and a major risk factor, one or more mechanical heart valves, or congestive heart failure with left ventricular ejection fraction less than 30%. Warfarin was discontinued 5 days before the procedure, and 1 of 3 dalteparin regimens was started: 5000 units SC od, 200 units/kg SC od, or 120 units/kg SC bid. Dalteparin therapy was continued until 24 h before the surgery and then restarted 12 h after the procedure, along with warfarin. Dalteparin was continued until the international normalized ratio was within the therapeutic range. Rates of thromboembolic and hemorrhagic complications were recorded, and the number of hospital days avoided was estimated. Results: The 47 participants underwent the following procedures: removal of colonic polyp (9 patients); cardiac catheterization (8); orthopedic surgery (7); colonoscopy, endoscopy, or bronchoscopy (7); dental surgery (6); ocular surgery (2); surgical biopsy (2); and nephrectomy, splenectomy, prostatectomy, oopherectomy, vasectomy, and endarterectomy (1 each). Two patients (4%, 95% confidence interval [CI] 1% to 14%) experienced a thromboemoblic event, 2 patients (4%, 95% CI 1% to 14%) had minor hemorrhage, and no patients had major hemorrhage in the perioperative period. Conclusion: Patients undergoing long-term anticoagulation who are at high risk for thromboembolic complications can be safely and effectively treated with low-molecular-weight heparin on an outpatient basis according to a hospital-based perioperative treatment model of care. RESUME Objectif : Evaluer l’efficacite et l’innocuite d’un programme perioperatoire ambulatoire a l’hopital pour les patients a risque de complications thromboemboliques chez qui l’on doit interrompre temporairement leur anticoagulotherapie orale en preparation d’une chirurgie dentaire, d’une operation ou d’une intervention diagnostique. Methodes : Une etude prospective de cohortes a ete menee aupres d’une serie consecutive de patients a haut risque qui prenaient des anticoagulants oraux a long terme et qui devaient subir une intervention chirurgicale au cours de la periode d’etude de 12 mois. Les patients a haut risque etaient ceux qui presentaient l’un ou l’autre des etats suivants : thromboembolie veineuse recente ou recidivante; fibrillation auriculaire avec un facteur de risque grave; une ou deux valves cardiaques artificielles; ou insuffisance cardiaque avec fraction d’ejection ventriculaire gauche de moins de 30 %. Leur traitement a la warfarine a ete interrompu cinq jours avant l’intervention et on a amorce leur traitement a la dalteparine selon l’un des trois schemas posologiques suivants : 5000 unites SC od; 200 unites/kg SC od; 120 unites/kg SC bid. Le traitement a la dalteparine a ete interrompu 24 heures avant l’intervention, puis repris 12 heures apres, avec le traitement a la warfarine. Le traitement a la dalteparine a ete administre jusqu’a ce que le rapport international normalise soit dans la marge therapeutique. On a compile les taux de complications thrombotiques et hemorragiques et evalue le nombre de jours d’hospitalisation epargnes. Resultats : Les 47 participants ont subi les interventions suivantes : ablation de polypes du colon (9 patients); catheterisme cardiaque (8); chirurgie orthopedique (7); coloscopie, endoscopie ou bronchoscopie (7); chirurgie dentaire (6); chirurgie oculaire (2); biopsie chirurgicale (2); nephrectomie, splenectomie, prostatectomie, ovariectomie, vasectomie et endarteriectomie (une de chaque). Deux patients (4 %, intervalle de confiance [IC] a 95 % : 1 % a 14 %) ont eu un accident thromboembolique, deux autres (4 %, CI a 95 % : 1 % a 14 %) ont eu une hemorragie legere, mais aucun n’a eu d’hemorragie grave au cours de la periode perioperatoire. Conclusion : Les patients qui sont sous anticoagulotherapie au long cours et qui presentent un risque eleve de complications thrombotiques peuvent recevoir en clinique externe un traitement sur et efficace a l’heparine de faible poids moleculaire, dans le cadre d’un programme de soins perioperatoires a l’hopital.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.010 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".