Real-Life Indications for Left Atrial Appendage Occlusion in Nonvalvular Atrial Fibrillation: Choosing Between Clinical Trials and Clinical Pragmatism
Bibliographic record
Abstract
ercutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative therapy to long-term oral anticoagulation (OAC) for the prevention of cardioembolic strokes in patients with nonvalvular atrial fibrillation (NVAF) and an elevated bleeding risk.In the pivotal PROTECT AF trial (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) and PREVAIL trial (Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), patients with NVAF, high thromboembolic risk, and who were suitable for long-term OAC were randomized to LAAO or warfarin.[1][2][3] The 5-year pooled analysis of these trials demonstrated no difference in the risk of the composite of stroke, systemic embolism, or cardiovascular/unexplained death between patients randomized to LAAO or warfarin; however, the risk of allcause death, cardiovascular death, hemorrhagic stroke, disabling stroke, and postprocedural major bleeding was lower among patients randomized to LAAO. 4 A pragmatic interpretation of these pivotal trials is that LAAO is a reasonable and relatively safe alternative to chronic warfarin use in patients with NVAF at high risk of stroke.
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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 | 0.032 | 0.158 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.007 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.066 | 0.048 |
| Insufficient payload (model declined to judge) | 0.005 | 0.004 |
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".