Fondaparinux Versus Argatroban and Danaparoid for the Treatment of Suspected or Confirmed Heparin-Induced Thrombocytopenia: A Propensity Score Analysis.
Bibliographic record
Abstract
Abstract Abstract 2262 Background: Heparin-induced thrombocytopenia (HIT) is a complication of heparin therapy leading to platelet activation, thrombocytopenia and potentially thrombosis. Upon suspicion, current guidelines recommend heparin cessation and switching to a non-heparin anticoagulant such as argatroban or danaparoid. Fondaparinux could be potentially effective but information supporting its use is limited. Methods: We retrospectively evaluated 239 patients admitted to London Health Sciences Centre from January 10, 2004 to June 21, 2011 receiving a non-heparin anticoagulant (133 fondaparinux, 59 danaparoid, 47 argatroban) for suspected or confirmed HIT. Using logistic regression a propensity score was constructed based on age, gender, creatinine, 4T scores and comorbidities (assessed by the Charlson comorbidity index modified by Quan) and used to match 133 patients to 60 controls. Efficacy outcome was thrombosis or thrombosis-related death. Safety outcome was major bleeding. Group comparisons were done using χ2, Fisher's exact or Mann-Whitney tests. Survival analysis was conducted using the Kaplan-Meier method. Analyses were conducted in SPSS 20.0 and R 2.12. Results: Population characteristics are shown in Table 1. Well-balanced groups were obtained after matching. There were no differences in the proportion of thrombotic or bleeding events between control and fondaparinux groups (Table 2). Subgroup analyses comparing fondaparinux versus argatroban or danaparoid and unmatched analyses showed similar results. Sensitivity analysis stratified by propensity score quintiles showed no differences in either outcome. Survival analysis showed no differences in thrombosis or bleeding (Log-rank p = 0.415 and 0.779, respectively; Figure 1). Subgroup survival analysis for the 3 drugs independently found no difference in thrombotic events (Log-rank p=0.582) and a trend towards increased major bleeding in patients on argatroban (Log-rank p=0.068). In the fondaparinux group 60% of patients received prophylactic doses. Conclusion: Fondaparinux has similar effectiveness and safety as argatroban and danaparoid in patients with suspected HIT. Prophylactic fondaparinux doses seem to be effective if no indication for full anticoagulation exists. Disclosures: Off Label Use: Fondaparinux as a treatment option in heparin-induced thrombocytopenia. Lazo-Langner:Pfizer: Honoraria; LeoPharma: Honoraria.
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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 | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".