Use and outcomes of anticoagulants for the treatment and prevention of thrombosis among hospitalized patients

摘要 在美国，每年有超过2 - 3百万人被处方抗凝剂用于治疗 和预防血栓栓塞病症。适用于从预防心房内卒中 纤颤到急性静脉血栓栓塞的治疗，抗凝剂可明显降低 与血栓栓塞相关的发病率和死亡率。然而，抗凝剂也与 出血的重大风险以及患者的成本和负担。本建议的总体目标是 更深入地了解抗凝剂在不同临床情况下的最佳使用，最终目标是 最大化他们的利益和最小化他们的风险。该提案的另一个过于雄心勃勃的目标是， 允许方博士建立在指导学员和教师的成功历史的基础上， 研究和指导计划，旨在培训初级研究人员，为病人的职业生涯做准备， 心血管结局研究。 本提案的研究目标将涉及药物预防策略的当代应用 为了预防关节置换术后静脉血栓栓塞，描述围手术期 需要中断长期抗凝治疗以接受治疗的患者的管理和结局 择期手术，并检查抗凝治疗满意度，健康相关 口服抗凝剂的患者的生活质量和药物依从性。这些目标将有助于告知 在临床实践中适当使用抗凝剂。 作为一名医院临床研究者，方博士担任大学的研究主任。 加州，旧金山弗朗西斯科（UCSF）医院医学分部。她的研究计划是基于 杰出的临床，培训和UCSF的研究环境。这项提案的目的将支持她 努力发展心血管结局研究人员，以及加强她的能力， 研究平台必须支持学员的研究。

ABSTRACT More than 2 – 3 million people are prescribed anticoagulants every year in the United States for the treatment and prevention of thromboembolic conditions. Used for indications ranging from stroke-prevention in atrial fibrillation to the acute treatment of venous thromboembolism, anticoagulants can significantly reduce the morbidity and mortality related to thromboembolism. However, anticoagulants are also associated with significant risks of bleeding, as well as costs and burden to patients. The overall objective of this proposal is to gain greater insight into the optimal use of anticoagulants in different clinical situations, with the ultimate goal being to maximize their benefits and minimize their risks. The other over-arching goal of the proposal is to allow Dr. Fang to build upon a successful history of mentoring trainees and faculty in order to develop a research and mentoring program geared towards training junior investigators preparing for careers in patient- oriented cardiovascular outcomes research. The research aims of this proposal will address the contemporary use of pharmacologic prevention strategies to prevent venous thromboembolism after joint replacement surgery, describe trends in the periprocedural management and outcomes of patients who need to interrupt chronic anticoagulant therapy in order to undergo elective surgery, and examine the association between anticoagulant treatment satisfaction, health-related quality-of-life, and medication adherence in people taking oral anticoagulants. These aims will help inform the appropriate use of anticoagulants in clinical practice. As a hospital-based clinician investigator, Dr. Fang serves as the Research Director for the University of California, San Francisco (UCSF) Division of Hospital Medicine. Her research program is based in the outstanding clinical, training, and research environment of UCSF. The aims of this proposal will support her efforts in developing cardiovascular outcomes researchers, as well as strengthen the capacity that her research platform has to support mentee research.