Anticoagulation Treatment and Long-Term Outcomes After Venous Thromboembolism

描述（由申请人提供）：静脉血栓栓塞（VTE）是美国最常见、危及生命的心血管疾病之一，每年导致超过35万人住院。静脉血栓栓塞的发病率一直在上升，随着美国和全球人口的老龄化，预计还会进一步上升。静脉血栓栓塞治疗的基础是抗凝治疗，虽然抗凝治疗非常有效，但与出血风险和繁重的监测相关。抗凝治疗的不良并发症在老年人和癌症患者中尤为严重，他们也是静脉血栓栓塞复发风险最高的患者。目前尚未开发出有效的风险分层工具，可以最佳地平衡静脉血栓栓塞复发风险和治疗出血性并发症，并且缺乏关于延长抗凝治疗时间的安全性和对长期预后的影响的数据，导致关于初始静脉血栓栓塞后最佳治疗时间的争议。制定能够更好地为预防和治疗静脉血栓栓塞的最佳做法提供信息的战略对公共卫生具有重要意义。该项目的长期目标是降低成人静脉血栓栓塞的发病率和死亡率，并评估当代治疗模式和静脉血栓栓塞后的长期结果。该项目将创建一个详细的纵向队列，包括2004-2007年间首次诊断为静脉血栓栓塞的成年人，该队列基于静脉血栓栓塞患者的行政登记，该登记是由参与国家心肺血液研究所赞助的心血管研究网络（CVRN）的4个地理上不同的健康计划合作开发的。当前申请的目标是通过详细的图表回顾和结果验证，通过临床条件、治疗模式和首次静脉血栓栓塞后的长期结果的重要信息来增加和更新这个管理数据库，直到2013年。本研究的具体目的是确定影响静脉血栓栓塞初始抗凝治疗类型、持续时间和质量的因素，量化静脉血栓栓塞复发和大出血结局的长期风险，并开发可用于预测静脉血栓栓塞复发和大出血的临床风险分层工具。将临床和结果数据与管理数据相结合，将创建一个VTE患者的队列，并进行长期随访，可以作为丰富的信息来源，用于促进比较有效性研究，在当代，现实世界的实践环境中解决最佳的VTE管理问题。

DESCRIPTION (provided by applicant): Venous thromboembolism (VTE) is one of the most common, life-threatening cardiovascular diseases in the US, causing over 350,000 hospitalizations each year. The rate of VTE has been rising over time and is expected to increase even further as the US and worldwide population ages. The cornerstone of VTE treatment is anticoagulation, which while very effective, is associated with significant bleeding risks and burdensome monitoring. Adverse complications from anticoagulation are particularly serious in older adults and individuals with cancer, who are also the patients at highest risk for recurrent VTE. Effective risk stratification tools that can optimally balance recurrent VTE risk with hemorrhagic complications of treatment have yet to be developed, and lack of data on the safety of extended-duration anticoagulant therapy and effect on long-term outcomes leads to controversy about the optimal duration of therapy after initial VTE. Establishing strategies that can better inform best practices in the prevention and treatment of VTE is of major public health importance. The long-range objective of this project is to reduce the morbidity and mortality associated with VTE in adults and evaluate contemporary treatment patterns and long-term outcomes after VTE. This project will create a richly-detailed longitudinal cohort of adults with first-time VTE diagnosed in years 2004-2007, based on an administrative registry of VTE patients developed through a collaboration of 4 geographically diverse health plans participating in the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Research Network (CVRN). The goals of this current application are to augment and update this administrative database with important information on clinical conditions, treatment patterns, and long-term outcomes after initial VTE until year 2013, obtained through detailed chart review and outcome validation. The specific aims of this study are to identify factors that influence the type, duration, and quality of initial anticoagulant treatment for VTE, quantify the long-term risk for recurrent VTE and major hemorrhagic outcomes, and develop clinical risk stratification tools that can be used to predict recurrent VTE and major hemorrhage. Combining clinical and outcome data with administrative data will create a cohort of VTE patients with extended follow-up that can serve as a rich source of information for use in facilitating comparative effectiveness research addressing optimal VTE management within contemporary, real-world practice settings. PUBLIC HEALTH RELEVANCE: Venous thromboembolism (VTE) is one of the most common, life-threatening cardiovascular diseases in the United States and results in significant morbidity, mortality, and costs. The objective of this project is to reduce the morbidity and mortality associated with VTE in adults and evaluate contemporary treatment patterns and long-term outcomes after VTE by developing a richly-characterized cohort of adults with VTE that can be used to answer numerous important questions about optimal VTE management within contemporary, real-world practice settings. This project will evaluate current treatment patterns for VTE, identify risk factors for adverse outcomes, and develop clinically applicable risk-stratification tools to help predict recurrent VTE and major hemorrhagic complications.