Abstract 16973: Thrombotic and Bleeding Outcomes of Pregnancy in Women With a Fontan Circulation
Bibliographic record
Abstract
Introduction: Patients with a Fontan circulation are at increased risk of bleeding as well as thrombosis. Current strategies to mitigate this risk during pregnancy are not well studied. Hypothesis: We hypothesize pregnant women with a Fontan circulation would have a higher risk of bleeding at baseline and anticoagulation (AC) therapy would increase this risk compared to antiplatelet (AP) therapy. Methods: This is an international multicenter retrospective cohort study of women with a history of Fontan palliation and pregnancy (2007-2017). Outcomes analyzed include AC/AP therapy and bleeding and thrombosis complications for each pregnancy. Results: There were 97 pregnancies in 74 women (26.9 +/- 4.6 years old, 25(25.5%) ending in miscarriage). Median gestational age at delivery was 35 weeks (IQR 7 weeks), with a birth weight of 2140grams (IQR 898). Bleeding complication occurred in 33 (35.1%) of pregnancies; the majority were from postpartum hemorrhage/PPH (30(88.2%)). 7(18%) patients required transfusion therapy. Of the 33 pregnancies with bleeding complications, 5 (15.2%) were on combination AC/AP therapy, 17 (50%) on isolated AC and 10 (29.4%) on isolated AP therapy. Only 1 patient with a bleeding event was on no therapy. In the non-bleeding complication cohort (n=37), 6 (16.2%) were on AC/AP therapy, 14 (37.8%) on isolated AC and 14 (37.8%) on isolated AP therapy. There were 3(8.1%) who received neither AC nor AP therapy. Thrombosis occurred in 2 patients (intracardiac n=1, thromboembolic event n=1), both of which were on combination AC/AP therapy. Conclusions: Bleeding risk is high in pregnant women with Fontan circulation, especially during the post-partum period. In this analysis, bleeding risk in those on therapy was higher than what is reported in non-Fontan populations receiving similar therapy. Further study is necessary to discern the relative contribution of anti-thrombotic and antiplatelet strategies to this risk. Thrombosis risk seems to have been effectively minimized with the above antithrombotic strategies.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".