4321Betrixaban versus enoxaparin for venous thromboembolism prophylaxis in critically ill patients: findings from the APEX trial
Bibliographic record
Abstract
Background: The efficacy and safety of venous thromboembolism (VTE) prophylaxis with non-vitamin K antagonist oral anticoagulant has not been evaluated in the critical care setting. Methods: The APEX trial randomized 7,513 acutely ill medical inpatients to betrixaban for 35–42 days or enoxaparin for 10±4 days. A total of 703 critically ill patients were included in the analysis, and 547 patients who had no severe renal insufficiency or P-glycoprotein inhibitor use were included in the full-dose stratum (betrixaban 80 mg daily vs. enoxaparin 40 mg daily). The risks of VTE (composite of deep venous thrombosis, pulmonary embolism, or VTE-related mortality), major bleeding, and clinically relevant non-major bleeding were compared between treatment arms at the end of thromboprophylaxis (through 42 days) and at the end of study (through 77 days). Results: Compared with enoxaparin, betrixaban reduced the risk of VTE at 42 days (4.27% vs. 7.95%, RR=0.54 [95% CI: 0.29–0.99], p=0.0417, NNT=28) and at 77 days (5.24% vs. 10.88%, RR=0.48 [0.26–0.87], p=0.0134, NNT = 18). Full-dose betrixaban was associated with a more profound benefit of VTE reduction at 42 days (RR=0.40 [0.19–0.85], p=0.0125, NNT=20) and at 77 days (RR=0.37 [0.18–0.77], p=0.0051, NNT=14), as well as a lower risk of major bleeding (RR=0.10 [0.01–0.79], p=0.0067, NNT=31). The rates of major or clinically relevant non-major bleeding were similar between betrixaban and enoxaparin in the overall population (3.70% vs. 3.41%, p=0.8330) and in the full-dose stratum (3.32% vs. 3.62%, p=0.8470).
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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 | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| 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".