Prévention de la thromboembolie veineuse chez les patients devant subir une chirurgie orthopédique
Bibliographic record
Abstract
Resume Objectifs : Discuter des choix de traitement dans la prevention des thromboembolies chez les patients devant subir une chirurgie orthopedique en fonction des nouvelles recommandations du 8e consensus de l’American College of Chest Physicians. Source des donnees : Nous avons effectue une revue de la litterature scientifique en consultant Pubmed et procede a l’analyse des etudes cliniques et des meta-analyses ainsi que des nouvelles lignes directrices relatives a la prevention de la thromboembolie veineuse. Analyse des donnees : La thromboembolie veineuse est une complication frequente dans le cadre des chirurgies orthopediques. Les lignes directrices guident les cliniciens quant a la facon, au moment et a la raison d’instaurer le traitement prophylactique, ainsi qu’au choix des candidats et traitements appropries. Le dabigatran-etexilate et le rivaroxaban ont ete evalues comme moyens preventifs de la thromboembolie veineuse de patients soumis a une arthroplastie totale de la hanche ou du genou et ont ete compares a l’enoxaparine. Les resultats montrent generalement la non-inferiorite de ces agents par rapport a l’enoxaparine et leur equivalence sur le plan de l’innocuite. Conclusion : Les patients qui doivent subir une chirurgie orthopedique sont exposes a un risque eleve de thromboembolie veineuse. Avec l’arrivee sur le marche de nouveaux agents administres par voie orale, dont l’efficacite et l’innocuite ont ete etablies dans la prevention de la thromboembolie veineuse chez les patients ayant subi une chirurgie orthopedique, les cliniciens seront appeles a interpreter les donnees afin de determiner si ces nouveaux agents peuvent s’inscrire dans leurs schemas therapeutiques. Abstract Objective: To discuss the choice of treatment for the prevention of thromboembolic events in patients undergoing orthopedic surgery, as a function of new recommendations from the American College of Chest Physicians (8th edition). Data source: A review of the scientific literature was done using PubMed. Clinical studies and metaanalyses were examined in addition to new guidelines for the prevention of venous thromboembolism. Data analysis: Venous thromboembolism is a frequent complication of orthopedic surgeries. Guidelines are available to help the clinician determine how, when, why, and on whom to start appropriate prophylactic treatment. Dabigatran etexilate and rivaroxaban have been compared to enoxaparin for the prevention of venous thromboembolism in patients having undergone total hip or knee arthroplasty. Results have shown these agents to be generally non-inferior and to have equivalent safety as compared to enoxaparin. Conclusion: Patients undergoing orthopedic surgery are at a high risk of developing venous thromboembolism. With the arrival of new oral agents on the market, agents in which safety and efficacy have been established in the prevention of venous thromboembolism in orthopedic surgery patients, clinicians will have to interpret the data to determine if these new agents can fit into their therapeutic schemas. Key words: thromboprophylaxis; orthopedic surgery; low molecular weight heparin; heparin; warfarin; fondaparinux; dabigatran etexilate; rivaroxaban.
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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 | 0.009 | 0.046 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".