课题基金 / 基金详情

A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major Hemorrhage

A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major Hemorrhage
大出血后重新开始口服抗凝治疗的以患者为中心的方法
批准号:
10404778
负责人:
Truman Milling
金额:
$6.43万
依托单位:
依托单位国家:
美国
项目类别:
财政年份:
2016
资助国家:
美国
项目状态:
已结题
起止时间:
2016-09-01 至 2022-03-09

项目摘要

项目成果

Truman Milling的其他基金

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中文摘要
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项目总结/文摘
英文摘要
Project Summary/Abstract Major hemorrhage on anticoagulants is a dramatic presentation that creates a bias against restarting the anticoagulant for fear of precipitating another hemorrhage. What often gets lost in this one-sided assessment of risk is the underlying threat of thromboembolic disease, for which the patient was anticoagulated to begin with. A more balanced approach between the risk of hemorrhage and stroke -- and prospective randomized data on which to base it -- is direly needed. This proposal is relevant to the mission of NHLBI as it deals with heart disease, since the most common indication for oral anticoagulation is atrial fibrillation. It deals with blood disease, albeit an iatrogenic coagulopathy caused by anticoagulation therapy. It deals with the clinical setting of bleeding, both in gastrointestinal bleeding and intracranial hemorrhage. It aims to enhance the health of patients with these diseases by studying the risk/benefit of restarting anticoagulation after major hemorrhage. Its goals are immediately translational into clinical practice. It fosters training and mentoring of an emerging scientist and physician, and it creates and supports a robust, collaborative research infrastructure in partnership with the private non-profit Seton Healthcare Family and the new University of Texas Dell Medical School in Austin. There are no evidence-based guidelines on when to restart warfarin after major hemorrhage, much less the Novel Oral Anticoagulants (NOACs) increasingly being used. The overall goal of this application is to elucidate a research plan to inform the clinical decision to restart anticoagulation after major hemorrhage that will establish Dr. Milling as an independent impactful researcher in this field. Dr. Milling will enroll in a formal master's degree program: Masters of Science in Clinical Investigations at the University of Texas Health Science Center – San Antonio. He will also undergo extensive and immersive training in hemostasis and coagulation, the design and conduct of multicenter clinical trials, conceptual training in the field of adaptive trial design, and health economics. Dr. Milling will receive careful mentorship from Drs. Steven Warach, Scott Berry Todd Olmstead and Jerrold Levy utilizing both formal training curriculum and informal meeting frameworks to draw from their extensive and diverse experience and guidance. Dr. Milling will conduct a three-phased research design, including the development of a National Practice Survey Tool for Clinical Trials (survey of patients, PCPs, and Cardiologists), laying the ground work for a larger multicenter, adaptive, “time dose” clinical trial and a future R01 submission, to find the ideal time to restart oral anticoagulants after a major hemorrhage that balances the risk of recurrent hemorrhage with the risk of thromboembolic disease.
期刊论文(38)
专著(0)
科研奖励(0)
会议论文
Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors.
与因子XA抑制剂相关的急性大量出血的Andexanet alfa。
DOI: 10.1056/nejmoa1607887
发表时间: 2016-09-22
期刊: The New England journal of medicine
影响因子: --
作者: [Connolly SJ, Milling TJ Jr, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, Bronson MD, Lu G, Conley PB, Verhamme P, Schmidt J, Middeldorp S, Cohen AT, Beyer-Westendorf J, Albaladejo P, Lopez-Sendon J, Goodman S, Leeds J, Wiens BL, Siegal DM, Zotova E, Meeks B, Nakamya J, Lim WT, Crowther M, ANNEXA-4 Investigators]
通讯作者: ANNEXA-4 Investigators
DOI: 10.1016/s1474-4422(18)30319-3
发表时间: 2018-12
期刊: The Lancet. Neurology
影响因子: --
作者: [Kasner SE, Swaminathan B, Lavados P, Sharma M, Muir K, Veltkamp R, Ameriso SF, Endres M, Lutsep H, Messé SR, Spence JD, Nedeltechev K, Perera K, Santo G, Olavarria V, Lindgren A, Bangdiwala S, Shoamanesh A, Berkowitz SD, Mundl H, Connolly SJ, Hart RG, NAVIGATE ESUS Investigators]
通讯作者: NAVIGATE ESUS Investigators
DOI: 10.1001/jamanetworkopen.2021.9175
发表时间: 2021-05-03
期刊: JAMA network open
影响因子: 13.8
作者: []
通讯作者:
DOI: 10.1161/strokeaha.120.029749
发表时间: 2020-11
期刊: Stroke
影响因子: 8.3
作者: [Warach SJ, Dula AN, Milling TJ Jr]
通讯作者: Milling TJ Jr
共 21 条
    A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major Hemorrhage
    • 批准号:
      9032932
    • 项目类别:
    • 资助金额:
      $13.47万
    • 财政年份:
      2016
    • 负责人:
      Truman Milling
    • 依托单位:
    A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major Hemorrhage
    • 批准号:
      10005444
    • 项目类别:
    • 资助金额:
      $13.12万
    • 财政年份:
      2016
    • 负责人:
      Truman Milling
    • 依托单位:
    A Patient Centered Approach to Restarting Oral Anticoagulant Therapy After Major Hemorrhage
    • 批准号:
      9765368
    • 项目类别:
    • 资助金额:
      $13.45万
    • 财政年份:
      2016
    • 负责人:
      Truman Milling
    • 依托单位:
    海外基金