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200-300万人被开出抗凝剂进行治疗 和预防血栓栓塞症。用于房室预防中风的适应症 纤颤急性期治疗静脉血栓栓塞症，抗凝治疗可明显降低 血栓栓塞症的发病率和死亡率。然而，抗凝剂也与 极大的出血风险，以及患者的成本和负担。这项提议的总体目标是 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，最大限度地减少他们的风险。该提案的另一个首要目标是 允许方博士在指导学员和教职员工的成功历史的基础上，制定一项 研究和指导计划，旨在培训初级调查人员，为患者的职业生涯做准备- 以心血管结果为导向的研究。 这项提案的研究目的将解决当代药理学预防策略的使用问题。 为预防关节置换术后静脉血栓形成，请描述围手术期的趋势。 需要中断慢性抗凝治疗的患者的管理和结果 择期手术，并检查抗凝剂治疗满意度与健康的关系 服用口服抗凝剂的人的生活质量和用药依从性。这些目标将有助于向 临床实践中抗凝药物的合理使用。 作为一名以医院为基础的临床医生研究员，方博士担任加州大学的研究主任 加州大学旧金山分校(UCSF)医院医学部。她的研究项目基于 加州大学旧金山分校优秀的临床、培训和研究环境。这项提案的目的将支持她 努力开发心血管结局研究人员，以及加强她的能力 研究平台必须支持导师的研究。

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.