Unfavourable effects of medically indicated oral anticoagulants on survival in idiopathic pulmonary fibrosis: methodological concerns
Bibliographic record
Abstract
We read the correspondence of L. Kawano-Dourado and colleagues related to our article “Unfavourable effects of medically indicated oral anticoagulants on survival in idiopathic pulmonary fibrosis” with great interest [1]. There is compelling evidence of an association between disturbances in the coagulation system and idiopathic pulmonary fibrosis (IPF); however, results from the ACE-IPF (anticoagulant effectiveness in idiopathic pulmonary fibrosis) randomised controlled trial of the vitamin K antagonist warfarin demonstrated deleterious effects of anticoagulation in IPF [2]. Based on these data, the recent update of the international guideline on IPF gave a strong recommendation against the use of anticoagulants [3]. Yet, the potential risks of medically indicated anticoagulation on mortality and other clinical outcomes in IPF remain unexplored. This is an important clinical question as almost one in every five patients with IPF receives anticoagulants for different indications [4]. In this regard, our post hoc analysis, which describes that patients in the placebo groups treated with anticoagulants in the CAPACITY and ASCEND trials had a higher rate of all-cause and IPF-related mortality compared with non-users, adds further insights in to the potential hazard of anticoagulant use in IPF [1]. We agree with Kawano-Dourado and colleagues that these data should be interpreted in light of the inherent limitations of a post hoc analysis based on a small number of events. However, these data represent, to our knowledge, the largest cohort of IPF subjects in whom this question has been addressed. Furthermore, our data are in line with two retrospective studies in IPF populations that also report a significantly higher risk of mortality in association with the use of anticoagulants for medical indications [5, 6] and this important clinical problem has recently also been highlighted by others [7]. Comorbidities requiring anticoagulants may not explain unfavourable effects of these drugs on survival in IPF
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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 | 0.357 | 0.667 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.009 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.007 | 0.003 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 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".