Characterization of Antithrombotic Regimens for Patients with Nonvalvular Atrial Fibrillation and Obesity Discharged from Cardiology Wards
Bibliographic record
Abstract
Background: Despite data derived from observational studies, optimal anticoagulation strategies have yet to be established for patients with nonvalvular atrial fibrillation and obesity. Objective: To describe direct oral anticoagulant (DOAC) regimens prescribed for adult patients with nonvalvular atrial fibrillation who weighed more than 120 kg. Methods: This single-centre, retrospective cohort study, conducted in the Saskatchewan Health Authority – Regina Area, involved adult patients with body weight greater than 120 kg who had an indication for oral anticoagulation to treat nonvalvular atrial fibrillation and were discharged by a cardiologist between June 2019 and July 2021. Results: A total of 62 patients were included (median weight 135 kg). At discharge, DOACs were prescribed for 57 (92%) of the patients and warfarin for 5 (8%). In numeric terms, patients receiving warfarin were at higher risk of thromboembolism or thrombosis; however, the small sample size limited the ability to draw conclusions. Conclusions: Practice patterns in the Saskatchewan Health Authority – Regina Area indicated substantial use of DOACs for patients with body weight greater than 120 kg; however, for those with the highest weights, warfarin was still in use. Keywords: atrial fibrillation, obesity, direct oral anticoagulants, anticoagulation, pharmacist interventions, pharmacist RÉSUMÉ Contexte : Malgré les données dérivées d’études observationnelles, les stratégies d’anticoagulation optimales n’ont pas été consolidées pour les patients atteints de fibrillation auriculaire non valvulaire et d’obésité. Objectif : Décrire les schémas thérapeutiques d’anticoagulants oraux (ACO) prescrits aux patients adultes atteints de fibrillation auriculaire non valvulaire et qui pesaient plus de 120 kg. Méthodes : Cette étude de cohorte rétrospective monocentrique menée dans l’office de la santé de la Saskatchewan à Regina a porté sur des patients adultes pesant plus de 120 kg qui avaient une indication de traitement anticoagulant oral pour traiter la fibrillation auriculaire non valvulaire et qui ont été renvoyés par un cardiologue entre juin 2019 et juillet 2021. Résultats : Au total, 62 patients ont été inclus (poids médian, 135 kg). Au congé, des ACO ont été prescrits à 57 (92 %) des patients et de la warfarine à 5 (8 %) d’entre eux. En termes numériques, les patients traités par warfarine présentaient un risque plus élevé de thromboembolie ou de thrombose; cependant, la petite taille de l’échantillon a limité la capacité de tirer des conclusions. Conclusions : Les modèles de pratique de l’office de la santé de la Saskatchewan à Regina indiquaient une utilisation importante des ACO pour les patients dont le poids corporel était supérieur à 120 kg; cependant, pour les personnes ayant le poids le plus élevé, la warfarine était toujours utilisée. Mots-clés : fibrillation auriculaire, obésité, anticoagulants oraux, anticoagulation, interventions du pharmacien, pharmacien
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".