Use and outcomes of anticoagulants for the treatment and prevention of thrombosis among hospitalized patients

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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.