Efficacy and safety of direct oral anticoagulants compared with warfarin in antiphospholipid syndrome. Results of a multicenter retrospective cohort study
Bibliographic record
Abstract
Background: Direct oral anticoagulants (DOACs) have become firstline treatment for many thrombotic conditions, but their use in antiphospholipid syndrome (APS) patients remains controversial. Objectives: This multicenter, retrospective cohort study conducted at Emory and McMaster University Medical Centers aimed to explore pattern of DOAC use among APS patients and compare the efficacy and safety of DOACs vs warfarin. Methods: We included APS patients aged ≥18 years who experienced acute thrombosis between 2012 and 2018 and initiated DOACs or warfarin. Clinical endpoints were recurrent thrombosis, clinically relevant bleeding, and a composite of thrombosis and bleeding (net clinical benefit). Cox proportional hazards models estimated hazard ratios (HRs) for the clinical endpoints and defined DOAC or warfarin exposure as time-varying to account for anticoagulant switching. Results: A total of 152 patients were identified: 77 initiated treatment with warfarin and 75 with DOACs. Sixty patients switched anticoagulation therapy at least once. Twenty-four patients had triple-positive antiphospholipid antibodies anticoagulation class (DOAC vs warfarin) did not influence risk of recurrent thrombosis (HR, 0.91; 95% CI, 0.46-1.79) or net clinical benefit (HR, 0.81; 95% CI, 0.46-1.43). Conversely, DOACs were associated with 57% reduction in risk of clinically relevant bleeding (HR, 0.43; 95% CI, 0.20-0.95). The risk of recurrent venous or arterial thrombosis was comparable between DOAC and warfarin cohorts. Conclusion: This study demonstrated comparable efficacy and improved safety of DOACs over warfarin in a predominantly lower-risk APS population. Caution is advised, particularly in APS patients with triple-positive antiphospholipid antibodies or history of arterial thrombosis.
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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 | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".