Indefinite anticoagulation with reduced-intensity direct oral anticoagulants in patients with splanchnic vein thrombosis. An international practice survey
Bibliographic record
Abstract
INTRODUCTION: Low-dose direct oral anticoagulants (DOACs) could be beneficial for secondary prevention of splanchnic vein thrombosis (SVT) in subgroups of patients at high risk for recurrence. In the absence of direct evidence, we aimed to identify the practice preferences of physicians managing patients with SVT in an international web-based survey. METHODS AND RESULTS: An anonymous questionnaire was sent via E-Mail between April and July 2023 to members of 14 national and international scientific societies. We received 236 responses of which 175 were complete responses. After an initial 3-6 months of SVT treatment, more than 80% of respondents would continue anticoagulation in the presence of cancer, myeloproliferative neoplasms, or in case of unprovoked SVT. If anticoagulation is continued, 45.8-68.6% would use reduced-intensity dosing of DOACs. In case of compensated cirrhosis or controlled inflammatory bowel disease (IBD), 54.3% and 44.4% of respondents would continue anticoagulation and 68.8% and 73.3% would opt for reduced-intensity DOAC dosing, respectively. Gastroenterologists were more likely to discontinue anticoagulation in SVT associated with cancer, controlled IBD, or unprovoked event, and more likely to continue anticoagulation in compensated cirrhosis compared to other specialists. Overall, 96% of respondents supported prospective evaluation of low-dose DOACs for the secondary prevention of SVT. CONCLUSION: This survey showed that physicians adapt duration and intensity of anticoagulation therapy depending on the patient's specific condition and risk factors even in the absence of high-quality evidence. Prospective evaluation is awaited.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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 | 0.001 | 0.000 |
| 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".