345 Spicing up the Edmonton Anticoagulation protocol: interference of dietary curcumin on coagulation status during mechanical circulatory support with berlin heart LVAD
Bibliographic record
Abstract
In patients with implanted Berlin Heart EXCOR® Ventricular Assist Device, appropriate anticoagulation and antiaggregation within pre-defined values are essential for proper device function, and vital in order to avoid complications such as thromboembolic events and/or bleeding. Important factors that contribute to achieve the desired coagulation control are patient’s pharmacogenomics, liver status with nutritional status and interactions with other medications and supplements given to the patient during treatment. Bleeding or clotting issues that could occur are addressed according to aetiology, site of the incident, laboratory and clinical parameters. We describe a 3-year-old female patient with restrictive cardiomyopathy and acute heart failure subjected to implantation of Berlin Heart EXCOR® paediatric Left Ventricular Assist Device mechanical support as bridge therapy to cardiac transplantation. After device implantation, anticoagulation and antiaggregation were started and maintained according to the Edmonton Anticoagulation and Platelet Inhibition Protocol. Achievement of appropriate anticoagulation was compromised due to a non-disclosed addition of turmeric in her dietary regimen by parents. Curcumin, a polyphenol responsible for the yellow colour of turmeric, possesses anticoagulant properties, prolongs aPTT and PT significantly and inhibits thrombin and FXa activities. As a result, unexpected oscillations in the coagulation profile occurred, which represented a substantial management challenge. The aim of this report is to analyse and discuss the factors that could have been contributed to the difficult control of anticoagulation in our patient, with emphasis on the potential danger of undetected compounds deriving from sub-optimal control of paediatric patients during parental presence in PICU.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".