Efficacy and safety of different bridging regimens of parenteral anticoagulation after mechanical valve replacement
Bibliographic record
Abstract
Background: Limited evidence exists to guide the use of parenteral anticoagulation in the early postoperative period following mechanical valve replacement (MVR). The purpose of this study was to determine the practice patterns of anticoagulant management in patients undergoing MVR and to compare the 30 day rates of thrombotic and bleeding complications for patients receiving therapeutic vs. non-therapeutic bridging regimens. Methods: We conducted a retrospective chart review of all patients undergoing MVR at five Canadian cardiac surgery centers between January 1, 2003 and December 31, 2010. The primary efficacy outcome was thromboembolism (stroke, transient ischemic attack, systemic embolism or valve thrombosis). The primary safety outcome was major bleeding. Secondary outcomes included venous thromboembolism and death. Treatment effects were assessed using a matched propensity score analysis. Results: We included 1777 patients (mean age 58 years, 40% female) of whom 939 (56%) underwent isolated aortic valve replacement, 578 (34%) isolated mitral valve replacement, and 171 (9%) combined aortic and mitral valve replacement. 944 patients (53%) received therapeutic bridging and 749 patients (42%) received non-therapeutic bridging. Twenty-three patients (2.4%) who received therapeutic bridging versus thirteen patients (1.7%) who received non-therapeutic bridging experienced the primary efficacy outcome (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.65 to 3.59, P=0.33). Fifty-two patients (5.5%) in the therapeutic dosing group vs. twelve patients (1.6%) in the non-therapeutic dosing group experienced the primary safety outcome of major bleeding (OR 4.61; 95% CI, 2.15 to 9.87; P <0.0001). Conclusion: In the early postoperative period following MVR, therapeutic bridging anticoagulation was associated with a similar risk of thromboembolic complications and a significantly increased risk of major bleeding compared to non-therapeutic bridging anticoagulation.
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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 | 0.003 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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".