Clinical Implications from Recent Trials and New Guidelines for Stroke Prevention in Atrial Fibrillation
Bibliographic record
Abstract
After the release of the 2010 guidelines of the European Society of Cardiology (ESC) and the 2011 update of the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), new evidence has emerged that requires adaption of current clinical practice in the treatment of atrial fibrillation (AF). In 2011, results were published from two central AF trials concerning prevention of stroke in patients with AF: the Rivaroxaban Once daily oral direct factor Xa inhibition Compared with vitamin K antagonist for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) and the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study. Other important aspects that have emerged since 2010 include findings of stroke risk in paroxysmal AF patients, prediction for AF-associated stroke and haemorrhage, risk–benefit considerations concerning oral anticoagulation in patients with chronic kidney disease and risk–benefit considerations with use of antiplatelet agents, alone, combined, or in combination with oral anticoagulants in AF patients. Canadian AF guidelines were updated earlier this year, incorporating the new evidence. Also, in 2012, the American College of Chest Physicians released guidelines for the antithrombotic therapy of AF. Similar updates of the ESC and the AHA/ACC guidelines are expected, which will include new findings from the cardiovascular congresses over the upcoming months. Additionally, also in 2012, the Heart Rhythm Society, the European Heart Rhythm Association and the European Cardiac Arrhythmia Society (HRS/EHRA/ECAS) released a consensus statement on the interventional treatment of AF. The following short review summarises these new data and furthermore highlights our current clinical practice.
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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 | 0.132 | 0.363 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.003 | 0.007 |
| Scholarly communication | 0.018 | 0.014 |
| Open science | 0.007 | 0.005 |
| Research integrity | 0.022 | 0.035 |
| Insufficient payload (model declined to judge) | 0.013 | 0.010 |
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".