Association of direct oral anticoagulant–anticonvulsant coprescription with clinical outcomes in older adults: a population-based cohort study
Bibliographic record
Abstract
BACKGROUND: Anticonvulsants vary in their theoretical propensity to interact with direct oral anticoagulants (DOACs). Coprescription may reduce DOAC efficacy and increase risk of thromboembolism. OBJECTIVES: To evaluate the risk of clinical outcomes - thromboembolism, major bleeding, and death - among patients who were receiving a DOAC and newly treated with an interacting anticonvulsant relative to those newly treated with a non-interacting anticonvulsant. METHODS: We undertook 3 cohort studies using administrative health care data for Ontarians aged ≥66 years who were using a DOAC and newly prescribed 1 of 3 groups of anticonvulsants with declining theoretic propensity for interaction: group 1 (strongly interacting); group 2 (mildly interacting); and group 3 (potentially interacting). Each cohort was compared with a reference group of patients who were newly coprescribed a DOAC with a presumed noninteracting anticonvulsant. The primary outcome was hospitalization for thromboembolism. Secondary outcomes were major bleeding, death, and a composite of thromboembolism or death. Analysis was by propensity score inverse probability of treatment weighted competing risk Fine-Gray regression models. RESULTS: We studied 17 325 patients: 878 in group 1; 313 in group 2; 943 in group 3; and 15 191 in the reference group. After inverse probability of treatment weighted, we did not observe an association with thromboembolism or major bleeding in groups 1 to 3. The Cox proportional hazards ratio for death in those prescribed group 1 anticonvulsants was 2.21 (95% CI, 1.77-2.75). CONCLUSION: In patients using a DOAC and newly prescribed a group 1, 2, or 3 anticonvulsant, we did not observe an increased risk of thromboembolism. In patients newly coprescribed a DOAC with a group 1 anticonvulsant, the observed increased risk of death is likely due to residual confounding.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 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".