Anticoagulation Treatment and Long-Term Outcomes After Venous Thromboembolism

描述(申请人提供)：静脉血栓栓塞症(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350,000人住院治疗。随着时间的推移，VTE的比率一直在上升，预计随着美国和世界人口的老龄化，VTE的比率还会进一步上升。静脉血栓栓塞术的基础是抗凝，这虽然非常有效，但也伴随着显著的出血风险和繁重的监测。抗凝的不良并发症在老年人和癌症患者中尤其严重，他们也是VTE复发的最高风险患者。有效的风险分层工具可以最佳地平衡复发的VTE风险和治疗的出血性并发症，而且缺乏关于长期抗凝治疗的安全性和对长期结果的影响的数据，导致对首次VTE后的最佳治疗时间存在争议。制定能够更好地为预防和治疗静脉血栓栓塞症的最佳做法提供信息的战略具有重大的公共卫生重要性。该项目的长期目标是降低成人VTE的发病率和死亡率，并评估VTE后的当代治疗模式和长期结果。该项目将根据参与国家心肺血液研究所赞助的心血管研究网络(CVRN)的4个不同地理位置的健康计划合作开发的VTE患者管理登记，创建2004-2007年首次诊断为VTE的成年人的详细纵向队列。这项当前应用的目标是通过详细的图表审查和结果验证，使用关于初始VTE后至2013年的临床状况、治疗模式和长期结果的重要信息来增强和更新这个管理数据库。这项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VTE复发和重大出血结局的长期风险，并开发可用于预测VTE复发和重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，将创建一组具有长期随访的VTE患者，这些患者可以作为丰富的信息来源，用于促进比较有效性研究，解决当代现实世界实践环境中的最佳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.