Peripheral Thrombosis and Necrosis after Minimally Invasive Redo Mitral Valve Replacement due to Unknown Etiology: Difficult Diagnosis of Heparin Induced Thrombocytopenia
Bibliographic record
Abstract
We report on a 75-year-old male with acute onset of peripheral thrombosis causing necrosis of the fingers, elbow, and toes associated with thrombocytopenia after minimally invasive redo mitral valve replacement. Both warfarin and dalteparin were commenced on postoperative day 1 and his INR reached 2.1 on postoperative day 4. On postoperative day 5, the patient developed peripheral thrombosis which progressed to necrosis on postoperative day 6. Platelet counts decreased significantly on the same day. His clinical features were compatible with heparin induced thrombocytopenia (HIT). However, serology testing was negative and the diagnosis was never confirmed. The patient was treated for HIT and platelet count improved eventually. Although no clear consensus exists, we believe this case illustrates why therapy for HIT should be initiated when clinical features strongly suggest HIT despite a negative serology test, unless an alternate diagnosis can be found.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 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".