Abstract 4762: Cessation of Rivaroxaban in Post-ACS Patients is Not Associated With Clinical Evidence of Rebound Hypercoagulability: An ATLAS ACS-TIMI 46 Substudy
Bibliographic record
Abstract
Introduction : In vitro and outcome studies suggest that rebound hypercoagulability is present after cessation of some anticoagulants. Rivaroxaban is an oral, direct factor Xa inhibitor that has been shown to reduce major atherothrombotic events in post-ACS patients. Whether rivaroxaban is associated with rebound hypercoagulability in this population remains undefined. Methods : ATLAS ACS-TIMI 46 randomized post-ACS patients to placebo or rivaroxaban (5–20 mg) for 6 mos, with a 30 day follow-up visit. This analysis included 3367 subjects with ≥1 day follow-up after last study drug administration. Cox regression was used to assess the risk of events (primary: death, MI, stroke, or severe recurrent ischemia requiring revascularization; secondary: death, MI, or stroke) within 10 days of cessation of study drug. Results : Among subjects who completed the treatment period (N=2808), cessation of rivaroxaban and placebo was associated with a similar rate of the primary (HR 1.03, 95% CI 0.19–5.64) and secondary (HR 0.77, 95% CI 0.13–4.64) endpoints. Moreover, among subjects who discontinued study drug early (N±559), there were no significant differences in the risk of events after cessation of rivaroxaban and placebo (Figure ). Overall (N=3367), the risk of death or cardiovascular events after discontinuation of study drug was similar with rivaroxaban and placebo (primary: HR 1.28, 95% CI 0.59–2.77; secondary: HR 1.11, 95% CI 0.51–2.44). Conclusion : In post-ACS patients, discontinuation of rivaroxaban as compared with placebo is not associated with an increase in death or cardiovascular events, and thus there does not appear to be clinical evidence of rebound hypercoagulability.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".