Thromboprophylaxis In Pregnancy: Are Current Guidelines Working?
Bibliographic record
Abstract
Thromboprophylaxis in pregnancy poses many challenges for physicians given the potential complications to both mother and fetus. Given the difficulty of enrolling this population in appropriately designed studies, current guidelines rely on results extrapolated from other populations and observational studies. The purpose of this quality assurance project is to examine thromboprophylaxis in pregnancy and ensure that, by following current practice-based guidelines, we are meeting treatment goals by providing therapy that is both safe and efficacious. A retrospective chart review was completed on all patients between 2008 and 2013 who were treated with prophylactic doses of anticoagulation during their antepartum/postpartum period. Each pregnancy was followed throughout gestation and postpartum to assess for thrombotic events, major bleeding (as per the International Society for Thrombosis and Haemostasis (ISTH) definition), and outcomes. A total of 44 patients were reviewed. Of these, 21 (48%) met criteria for recurrent miscarriage and 19 (43%) had documented thrombophilia. 19 (43%) had a previous history of VTE, and 18 of the 19 (95%) previous VTE were associated with increased hormonal states. There were no antepartum or postpartum thrombotic events. 4 (9%) patients underwent Doppler ultrasound for clinical suspicion of DVT, but all were negative studies. There were no major bleeding episodes. 15 (34%) patients reported some form of minor bleeding, which did not meet ISTH criteria for major bleeds. Of the 21 pregnancies that met criteria for previous recurrent miscarriage, 15 (71%) had successful term deliveries, 1 (5%) had fetal loss, and 5 (24%) unknown outcomes. Given the absence of recurrent thrombosis and major bleeding events in the population examined, it would appear that following current practice guidelines is both a safe and efficacious practice. Disclosures: No relevant conflicts of interest to declare.
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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 | 0.066 | 0.201 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.008 | 0.008 |
| Open science | 0.006 | 0.002 |
| Research integrity | 0.008 | 0.009 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
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".