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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

基本信息

批准号：
8669067
负责人：
MARGARET C. FANG
金额：
$ 53.66万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8669067
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 therapy duration tool treatment duration

项目摘要

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）是美国最常见的危及生命的心血管疾病之一，每年导致超过35万例住院治疗。随着时间的推移，VTE的发病率一直在上升，预计随着美国和全球人口老龄化，VTE的发病率将进一步上升。静脉血栓栓塞治疗的基础是抗凝治疗，虽然非常有效，但与显著的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其严重，他们也是复发性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静脉血栓栓塞风险与出血性并发症的治疗尚未开发，缺乏数据的安全性延长持续时间的抗凝治疗和对长期结果的影响，导致争议的最佳持续时间后初始静脉血栓栓塞治疗。制定能够更好地宣传预防和治疗VTE的最佳实践的战略具有重大的公共卫生意义。该项目的长期目标是降低成人VTE相关的发病率和死亡率，并评估VTE后的当代治疗模式和长期结局。该项目将创建一个丰富详细的纵向队列的成年人首次诊断的VTE在2004-2007年，根据行政登记的VTE患者通过4个地理上不同的健康计划参与国家心脏，肺，血液研究所赞助的心血管研究网络（CVRN）的合作开发。本申请的目的是通过详细的病历审查和结局验证，使用关于初始VTE后至2013年的临床状况、治疗模式和长期结局的重要信息来扩充和更新该管理数据库。本研究的具体目的是确定影响VTE初始抗凝治疗的类型、持续时间和质量的因素，量化复发性VTE和大出血结局的长期风险，并开发可用于预测复发性VTE和大出血的临床风险分层工具。将临床和结局数据与管理数据相结合，将创建一个延长随访的VTE患者队列，可作为丰富的信息来源，用于促进比较有效性研究，以解决当代现实世界实践环境中的最佳VTE管理。