Bibliographic record
Abstract
Traumatic brain injuries and cardiovascular deficiencies are two of the leading causes of death in the U.S. Antithrombotics are among the common medications used for the management of cardiovascular diseases. However, the nature of antithrombotic agents makes the management of any bleeding difficult. Therefore, they are either not given to patients with a risk of bleeding, or they are stopped immediately in cases of bleeding.General guidelines in the case of intracranial hemorrhage (ICH) involve stopping the use of antithrombotics and then restarting them once the bleeding has stopped. However, unlike other types of intracranial hematomas, subdural hematomas (SDHs) are prone to rehemorrhage after a time (weeks or even months after the initial incident). Despite the prevalence of complications potentially caused by antithrombotic medications in the management of SDHs, this subject has yet to be fully investigated.This research paper documents for the first time the effects of antithrombotic therapies on patients suffering from SDHs. More specifically, we study the management of antiplatelet aggregation agents and anticoagulants in patients with traumatic SDHs. Understanding the risks of antithrombotics at different SDH stages (e.g. presence of active bleeding, presence of small or large residuals, and absence of residuals) helps to prevent potentially critical hemorrhagic complications. This thesis is a retrospective research study of patients who were admitted to the Montreal General Hospital with an acute traumatic SDH and who needed antithrombotic therapy. The study found that continuing therapeutic antiplatelet therapy while an SDH is still present, poses a high risk of rehemorrhage (45% for patients with a small residual SDH and up to 90% for those with a large residual SDH). The risk of rehemorrhage that will require neurosurgical intervention is 47%. ANTITHROMBOTIC MANAGEMENT IN ACUTE SDHOur data also shows that withholding AAA therapy for an average of 50 days, while the SDH is still present, does not contribute to any significant adverse event. We found similar results for anticoagulant therapy. The risk of rehemorrhage associated with restarting anticoagulant therapy if an SDH is not fully resolved is 28.5% and 62.5% for small and large residuals SDHs respectively. Our data shows that withholding anticoagulant therapy for an average of 67 days, while an SDH is still present, cause adverse events in only 1.1% of our study population.In the majority of cases our findings suggest that the safest course is to wait until the subdural hematoma has completely resolved before reinitiating antithrombotic therapy. At the same time, the status of the SDH should be closely monitored, using CT-scans, so that therapy can be reinitiated as soon as is safe. For patients with a high risk of thrombo-embolic events, it might be wiser to restart antithrombotic therapy while closely following-up the SDH with help of CT-scan imaging.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".