4110Thromboembolic and bleeding risk of patients with left-sided mechanical heart prostheses: the FCSA-START-Valvole Study
Bibliographic record
Abstract
Background: Patients (pts) who have received a mechanical prosthetic heart valve implantation need to be treated with a vitamin K antagonist (VKA). Outcomes in relation to quality and intensity of anticoagulation are largely unknown. Purpose: In the frame of the START Register (Italian Survey on Anticoagulated Patients Register), we conducted an observational retrospective multicenter study among 33 centers affiliated to the Italian Federation of Anticoagulation Clinics (FCSA). Methods: FCSA centers follow patients for the management of anticoagulant treatment, perform INR laboratory tests and prescribe a written daily VKA dosage to patients. Patients were followed-up with the aid of specific dedicated softwares; quality of anticoagulation, as well as bleeding and thrombotic events occurring during the follow-up were recorded. Centers were asked to provide information on each patient in whom a left-sided mechanical prosthetic heart valve was implanted, with follow-up data. Results: We enrolled 3027 pts overall receiving a prosthetic valve; in this sub-study we analyze 2357 pts (77.9%) with mechanical prostheses, of whom 1928 (81.8%) on warfarin and 429 (18.2%) on acenocoumarol, followed for a median of 9.7 yrs. Median age at implantation was 59.0 (49.7–65.7) years. Aortic valves was 59.7% and mitral 28.8%. Males pts was 55.2%. More time was spent below the intended therapeutic range with valves in the mitral than in the aortic position (Table 1). During the follow-up, 163 thrombotic events and 239 major bleeds were recorded; the rate and number of the thombotic events in relation to the site of valve implantation are reported in Table 1. Relative risk for thromboembolism of mitral vs aortic prosthetic valve was 2.39 (95% CI 1.70–3.36; p<0.0001). No difference for bleeding risk was found in relation to valve position (rate ranging from 1.0–1.2).
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| 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".