Abstract WP149: Duration of Lead-In Parenteral Therapy and Outcomes in Individuals Treated With DOAC for Cerebral Venous Thrombosis: The ACTION-CVT Study
Bibliographic record
Abstract
Background: Direct oral anticoagulants (DOACs) are suitable for some patients with cerebral venous thrombosis (CVT). The optimal transition strategy from parenteral anticoagulation (PA) to DOAC is not known. We examined duration of PA prior to DOAC initiation and outcomes in ACTION-CVT, an international retrospective study. Methods: We compared three groups: no lead-in PA, 1-4 days (d) of PA, and 5-21d of PA. The primary outcome at day 90 (D90) was a composite of CVT recurrence/extension and symptomatic intracranial hemorrhage (sICH). Secondary outcomes (D90) were complete venous recanalization and mRS of 0-2. We evaluated outcomes using descriptive statistics and crude and adjusted logistic regression modeling. Results: Of 231 patients treated with DOAC, 11.7% had no lead-in PA, 64.5% 1-4d, 23.8% 5-21d. Compared to those with <5d, those with 5-21d had worse clinical-radiological presentations at baseline, including more focal deficits, encephalopathy, and ICH (Table 1). Primary outcome events were low overall; all 6 occurred in the <5d group. Odds of complete recanalization were lower in the <5d group, although this difference attenuated with adjustment for baseline characteristics. There were no differences in odds of mRS 0-2. (Table 2) Conclusions: Individuals treated with DOAC for CVT who received 5-21d of PA had more severe clinical and radiological presentations compared to those with <5d. Rates of CVT extension, recurrence and sICH were too low to reach conclusions regarding safety of one strategy over another. Odds of complete recanalization were higher in those with 5-21d PA, but these differences attenuated after adjustment for baseline patient characteristics.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".