ABSTRACT
Background: While commonly prescribed today, direct oral anticoagulants (DOACs) have historically been avoided in patients with class III obesity or a weight >120 kg due to limited literature regarding the efficacy and safety in this population. Objective: The overall objective was to examine the effectiveness of DOACs compared to warfarin in a population with obesity. Methods: Patients with a diagnosis of venous thromboembolism (VTE) or atrial fibrillation and a body mass index (BMI) ≥35 kg/m2 from August 1, 2015, to August 1, 2020, were included in this retrospective cohort study. Patients receiving a DOAC were matched in a 1:2 ratio to warfarin. The primary outcome was a composite of stroke or recurrent VTE. Secondary outcomes included the individual components of the primary outcome, hospitalization for bleed, and the primary outcome in patients with a BMI ≥40 kg/m2. Results: A total of 162 patients were included, with 54 and 108 in the DOAC and warfarin groups, respectively. Baseline BMI was similar between groups (45.7 kg/m2 for DOACs vs 43.8 kg/m2 for warfarin), with approximately 70% of patients having a BMI ≥40 kg/m2. The primary outcome occurred in 1 patient (1.9%) in the DOAC group and 2 patients (1.9%) in the warfarin group. The DOAC group had a higher, nonsignificant incidence of bleeding (5.6% vs 0.9%, P = 0.11). There was no difference between groups in incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), or stroke in patients with a BMI ≥40 kg/m2. Conclusion: DOACs may be as efficacious as warfarin in the prevention of stroke or recurrent VTE in patients with a BMI of ≥35 kg/m2. Prospective, randomized trials are warranted to further assess the efficacy and safety of DOACs in this population.
ABSTRACT
Knowledge surveys are a type of confidence survey in which students rate their confidence in their ability to answer questions rather than answering the questions. These surveys have been discussed as a tool to evaluate student in-class or curriculum-wide learning. However, disagreement exists as to whether confidence is actually an accurate measure of knowledge. With the concomitant goals of assessing content-based learning objectives and addressing this disagreement, we present herein a pretest/posttest knowledge survey study that demonstrates a significant difference correctness on graded test questions at different levels of reported confidence in a multi-semester timeframe. Questions were organized into Bloom's taxonomy, allowing for the data collected to further provide statistical analyses on strengths and deficits in various levels of Bloom's reasoning with regard to mean correctness. Collectively, students showed increasing confidence and correctness in all levels of thought but struggled with synthesis-level questions. However, when students were only asked to rate confidence and not answer the accompanying test questions, they reported significantly higher confidence than the control group which was asked to do both. This indicates that when students do not attempt to answer questions, they have significantly greater confidence in their ability to answer those questions. Additionally, when students rate only confidence without answering the question, resolution across Bloom's levels of reasoning is lost. Based upon our findings, knowledge surveys can be an effective tool for assessment of both breadth and depth of knowledge, but may require students to answer questions in addition to rating confidence to provide the most accurate data.
