P1669: DIRECT ORAL ANTICOAGULANTS VS LOW MOLECULAR WEIGHT HEPARIN IN THE MANAGEMENT OF PATIENTS WITH PRIMARY OR METASTATIC BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Topic: 34. Thrombosis and vascular biology - Biology & Translational Research Background: Patients with primary or metastatic brain tumours are at increased risk of thrombosis like other malignancies. Low-molecular weight heparin (LMWH) is the mainstay of current treatment/prophylaxis. Direct oral anticoagulants (DOACs) are increasingly used for various indications in the population of patients with malignancy. There is limited safety data for patients with primary or metastatic brain tumors as they were excluded from the large trials. Aims: To compare safety and efficacy of DOACs to LMWH in patients with primary and secondary brain tumors. Methods: We conducted a search of MEDLINE and Embase from inception to January 2023. We included randomized and non-randomized cohort studies that compared DOACs to LMWH. Two reviewers screened and extracted data at title/abstract and full-text levels individually and in duplicate. Baseline patient characteristics, details of brain tumour(s), and anticoagulation regimens were extracted. The primary safety outcome was intracranial hemorrhage (ICH). Data was meta-analyzed using random-effects model. Results: Of 287 articles capture in our search, six non-randomized studies (n = 565 patients) were included for analysis. 56% of patients had secondary intracranial tumors with the average duration of anticoagulation being 190 days for DOACs and 200 days for LMWH. There is a trend towards decreased ICH with DOACs as compared to LMWH(OR: 0.55 [95% CI - 0.29,1.07] I2 = 0%) Summary/Conclusion: There is a trend for increased safety of DOACs as compared to LMWH with regards to ICH. Use of DOAC in patients with brain tumours may be favored given their ease of administration. Randomized studies are needed to confirm these findings. Only preliminary analysis has been done thus far. Further planned analysis of these studies includes efficacy outcomes, as well as overall bleeding outcomes. Keywords: Anticoagulation, Oral anticoagulant, Anticoagulants
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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 | 0.008 | 0.018 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.028 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".