Abstract 11994: Reduced versus Standard Dose Apixaban in Patients With Atrial Fibrillation and Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial
Bibliographic record
Abstract
Background: Patients in AUGUSTUS (n=4614) taking apixaban without aspirin had less bleeding and fewer hospitalizations with no significant increase in ischemic events than those taking VKA, aspirin, or both. It is safe and efficacious to reduce apixaban from 5 mg to 2.5 mg twice daily in patients with AF and ≥2 of the following: age ≥80 years, weight ≤60 kg, serum creatinine ≥1.5 mg/dL. Data on reduced versus standard dose apixaban in patients with AF and ACS and/or PCI are limited. Methods: We assessed how many patients receiving apixaban 2.5 mg met the dose reduction criteria. We compared major or CRNM bleeding, death or rehospitalization, and death or ischemic events in those who appropriately received 2.5 mg apixaban, inappropriately received 2.5 mg apixaban, and appropriately received 5 mg apixaban. We determined the association of apixaban versus warfarin on bleeding and ischemic events in patients appropriately assigned 2.5 mg apixaban and appropriately assigned 5 mg apixaban. Results: Of 2290 patients assigned apixaban, 229 received 2.5 mg and 98 (43%) of those met reduced dose criteria. Rates of major/CRNM bleeding, death or rehospitalization, and death or ischemic events were higher in patients appropriately receiving 2.5 mg apixaban (13.7%, 34.7%, 12.2%) compared with those inappropriately receiving 2.5 mg apixaban (10.5%, 32.5%, 12.3%) and appropriately receiving 5 mg apixaban (11.0%, 23.0%, 5.7%). Compared with VKA, 2.5 mg apixaban, when used appropriately, resulted in similar or greater benefits than 5 mg apixaban for major/CRNM bleeding, death or rehospitalization, and death or ischemic events (Table). Conclusion: Of those in AUGUSTUS who received 2.5 mg apixaban, fewer than half met the reduced dose criteria. In patients with AF and recent ACS or PCI, appropriate use of reduced dose apixaban was associated with a lower risk of bleeding and similar rates of rehospitalization and ischemic outcomes compared with VKA, similar to that for standard dose apixaban.
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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 | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".