Trans-Catheter Aortic Valve Replacement Thrombus in Patient on Xarelto and Aspirin Resolved Three Months After Warfarin
Bibliographic record
Abstract
Trans-catheter aortic valve replacement has been gaining ground since it was performed in 2002. Indications for the procedure are also expanding and are expected to include patients with intermediate risk for perioperative mortality. There are no guidelines on the use of anticoagulation in patients who have undergone trans-catheter aortic valve replacement. We present an interesting case of an 82-year-old gentleman with past medical history of paroxysmal atrial fibrillation with CHA2DS2-VASc (a clinical prediction tool for estimating risk of stroke in patients with atrial fibrillation) score of 3, coronary artery disease, pernicious anemia, and severe symptomatic aortic stenosis who had trans-catheter aortic valve replacement. He was on Xarelto and aspirin, and still developed thrombus on the aortic valve many months after the procedure. The thrombus resolved after few months of anti-coagulation with Coumadin. This case shows that thrombus on the valve can still occur post-procedure even in patients who are on direct oral anticoagulant and aspirin. This calls into question if there is need to anti-coagulate all patients after TAVR procedure with Coumadin for at least 3 - 6 months. As our knowledge of the post-TAVR complications and outcomes continues to grow, we may be able to answer this question in the future, especially with large scale research studies. J Med Cases. 2018;9(8):278-280 doi: https://doi.org/10.14740/jmc3084w
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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) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".