The Prospective Use of Prothrombin Complex Concentrates in an Administrative Region of the Province of Quebec.
Bibliographic record
Abstract
Abstract Introduction: Prothrombin complex concentrates (PCCs) are used in the rapid reversal of warfarin and all other vitamin K deficiencies in patients with a major bleed or who require an urgent procedure. The Local Advisory Committee on Transfusion Medicine standardised a protocol for the use of PCCs, outlining the indications and contra-indications for their use. Methods: The charts of all patients having received PCCs between a two year period at the 4 hospital centers of region 12 were reviewed to evaluate the respect of guidelines, adherence to the protocol, and the clinical outcomes of patients. Results: From Nov. 2009 to Nov. 2011, 129 patients were treated with PCCs: 97 (75%) in the emergency department, 14 (11%) in the intensive care unit, 16 (12%) on medical or surgical floors, and 2 (1.5%) in the operating room. 116 prescriptions (90%) respected the guidelines; among the extra, 4 (3%) were for elective surgeries and 3 (2.3%) for an elevated INR without evidence of bleeding. One patient did not have an INR prior to administration, 10 (8%) did not have a repeat INR 30-minutes post-administration, and Vitamin K was omitted in 10 cases (8%). The prescription is based on weight: 120 (93%) received the correct dose, 3 (2.3%) received too high a dose, and 5 (3.8%) received too low a dose. The clinical outcome was favourable in 94 cases (73%), with rapid reversal of the INR and eventual discharge from hospital. 22 (17%) died during hospitalization and 10 (8%) were lost to follow-up due to transfer to a neurosurgical facility. The INR was less than 1.4 in 86% of cases 30-minutes post-administration. 6 (4.6%) thromboembolic complications occurred: two pulmonary embolisms, two deep vein thrombosis, one stroke, one disseminated intravascular coagulation. Five had resumed warfarin, but none had a therapeutic INR. Conclusion: Our review demonstrates that the majority of physicians correctly apply the recommended practice guidelines for the use of PCCs, that these are effective at rapidly reversing the INR, and are associated with favourable clinical outcomes in the majority of cases. However, thromboembolic events are frequent, emphasizing that anticoagulation therapy should be resumed quickly once clinically appropriate 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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".