Anticoagulation Treatment and Long-Term Outcomes After Venous Thromboembolism

静脉血栓栓塞后的抗凝治疗和长期结果

• 批准号: 8476262
• 负责人: MARGARET C. FANG
• 金额: $ 70.5万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8476262
• 关键词: Address; Adopted; Adult; Age; Anticoagulant therapy; Anticoagulants; Anticoagulation; Cardiovascular Diseases; Cardiovascular system; Characteristics; Clinical; Coagulation Process; Collaborations; Communities; Data; Databases; Development; Diagnosis; Elderly; Enrollment; Equilibrium; Event; Goals; Health Planning; Hemorrhage; Hospitalization; Image; Individual; Life; Link; Location; Low-Molecular-Weight Heparin; Malignant Neoplasms; Medical; Monitor; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Outcome; Patients; Pattern; Pharmaceutical Preparations; Population; Prevention; Principal Investigator; Public Health; Recording of previous events; Recurrence; Registries; Research; Residual state; Risk; Risk Factors; Safety; Scheme; Source; Stratification; Testing; Thromboembolism; Time; United States; Update; Validation; Variant; Vena Cava Filters; Venous; Warfarin; abstracting; administrative database; adverse outcome; base; clinical Diagnosis; clinical practice; clinical risk; cohort; comparative effectiveness; cost; demographics; dimer; effectiveness research; follow-up; high risk; mortality; patient registry; public health relevance; therapy duration; tool; treatment duration

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.

描述（由申请人提供）：静脉血栓栓塞（VTE）是美国最常见的，威胁生命的心血管疾病之一，每年导致超过350,000次住院。随着时间的流逝，VTE的速度一直在上升，随着美国和全球人口年龄的增长，预计将进一步上升。 VTE处理的基石是抗凝治疗，尽管非常有效，但与大量出血风险和负担重大的监测有关。在老年人和癌症患者中，抗凝抗凝作用的不良并发症特别严重，他们也是经常性VTE风险最高的患者。有效的风险分层工具可以最佳地平衡复发性VTE风险与出血并发症的治疗尚未开发出来，并且缺乏有关扩展尿液抗凝治疗的安全性的数据，以及对长期结局的影响导致有关初始VTE后治疗最佳持续时间的争议。建立可以更好地为预防和治疗VTE提供最佳实践的策略至关重要。该项目的远距离目标是降低成年人中与VTE相关的发病率和死亡率，并评估VTE之后的当代治疗方式和长期结果。该项目将根据2004 - 2007年诊断出的首次VTE的成年人的纵向纵向队列，该项目是根据VTE患者的行政注册中心诊断出的，该注册是通过参与国家心脏，肺部和血液研究所赞助的心血管研究网络（CVRN）的4个地理上多样化的健康计划而开发的。当前应用的目标是通过详细的图表审查和成果验证获得，并在首次VTE之后扩大和更新此行政数据库，并提供有关临床状况，治疗模式和长期结果的重要信息。这项研究的具体目的是确定影响VTE初始抗凝剂治疗的类型，持续时间和质量的因素，量化复发性VTE和主要出血结果的长期风险，并开发可用于预测复发性VTE和大量出血的临床风险分层工具。将临床和结果数据与行政数据相结合，将创建一组VTE患者，具有扩展的随访，可以作为丰富的信息来源，以促进比较有效性研究，以解决当代现实世界实践环境中最佳VTE管理。