Abstract 130: Deep Vein Thrombosis/Pulmonary Embolization in the Get With The Guidelines-Stroke Acute Ischemic Stroke Population: Incidence and Patterns of Prophylaxis
Bibliographic record
Abstract
Objective. Venous thomboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), represents a serious complication in hospitalized ischemic stroke patients. This study was undertaken to determine the incidence and patterns of prophylaxis for VTE in the GWTG-Stroke population. Methods. From 323,363 adult ischemic stroke patients enrolled in GWTG-Stroke, patients who were not admitted, had their stroke as an inpatient, died or discharged by day 2, ambulatory by day 2, ambulatory status unknown, VTE prophylaxis contraindicated, and comfort care by day 2 were excluded leaving 149,916 patients from 1,259 sites, of whom 136,432/149,916 (91%) had information on DVT/PE occurrence. Analysis of patient variables and site characteristics were performed in relation to reported administration of VTE prophylaxis. Multivariable models were constructed based on demographics, initial NIHSS, medical history, receipt of tPA or other therapy, and hospital characteristics. Results. The overall rate of DVT/PE was 3.01% (4,100/136,432). Excluding sites with VTE rates = 0% or >50% reduced this rate to 2.81% (3,408/121,276). The overall rate of VTE prophylaxis in the analysis cohort was 93% (139,476/149,916). Site prophylaxis rates were median 95% (25 th -75 th percentiles, 89%-98%) and ranged from 17% (1 site) to 100% (101 sites). Factors associated with increased likelihood of VTE prophylaxis in the multivariable model included history of atrial fibrillation/flutter (OR 1.50; 95% CI 1.42-1.59), receipt of IV (OR 1.24; 95% CI1.15-1.35) or IA tPA (OR 1.34; 95% CI 1.13-1.59), and admission to an academic hospital (OR 1.68; 95% CI 1.44-1.97). Increasing age (OR 0.95; 95% CI 0.94-0.96) and black race (OR 0.92; 95% CI 0.86-0.98), as well as history of peripheral vascular disease (OR 0.84; 95% CI 0.78-0.90), diabetes (OR 0.92; 95% CI:0.88-0.95), or prior stroke/TIA (OR 0.92; 95% CI 0.87-0.97) were associated with lower likelihood of prophylaxis. Patients receiving care in the Midwest region were less likely to receive prophylaxis compared to other regions (OR 0.73; 95% CI 0.61-0.88). Conclusions: Despite a high overall rate of prophylaxis, DVT/PE continue to occur in approximately 3% of GWTG-Stroke patients. Reported rates of VTE prophylaxis differ among hospitals by region, and among different patients by age, race, and medical co-morbidities.
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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 | 0.000 | 0.002 |
| 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 | 0.001 | 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".