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Studies in health technology and informatics

On-Premise Detection of a Guideline-Driven Oral Anticoagulation Shift in German Doctors' Letters Using Local Large Language Models

Using an on-premise fine-tuned Llama-3.1-70b medication information extraction pipeline, the study automatically extracted medication information from 538 unannotated routine 2012 doctors' letters and compared them with 500 CARDIO:DE letters from 2020/21 (using gold-standard annotations), finding that the DOAC proportion rose from 16.9% to 59.9% while the VKA proportion fell from 37.7% to 9.9%, that the dominant active ingredient within DOACs shifted from rivaroxaban to apixaban, and that manual review showed remaining errors were mainly linked to generic medication mentions and missing medication-reason relations rather than incorrect extraction.