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：
8133874
负责人：
MARGARET C. FANG
金额：
$ 76.93万
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 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8133874
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 effect clinical practice cohort comparative effectiveness cost demographics dimer effectiveness research follow-up high risk mortality patient registry public health relevance 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. 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.

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 350,000 人住院。随着时间的推移，VTE 的发生率一直在上升，并且随着美国和全球人口老龄化，预计还会进一步上升。 VTE 治疗的基石是抗凝，虽然非常有效，但会带来显着的出血风险和繁琐的监测。抗凝引起的不良并发症对于老年人和癌症患者尤其严重，他们也是复发 VTE 风险最高的患者。尚未开发出有效的风险分层工具，可以最佳地平衡复发性 VTE 风险与治疗出血并发症，并且缺乏关于延长抗凝治疗的安全性和对长期结果的影响的数据，导致关于最佳治疗持续时间的争议初始 VTE 后的治疗。制定能够更好地指导 VTE 预防和治疗最佳实践的策略对于公共卫生具有重要意义。该项目的长期目标是降低成人 VTE 相关的发病率和死亡率，并评估当代治疗模式和 VTE 后的长期结果。该项目将创建一个详细的纵向队列，其中包括 2004 年至 2007 年首次诊断出 VTE 的成年人，该队列的基础是 VTE 患者的管理登记，该登记是通过参与国家心肺、肺、心肺疾病的 4 个不同地区的健康计划合作开发的。和血液研究所赞助的心血管研究网络 (CVRN)。当前应用程序的目标是通过详细的图表审查和结果验证获得有关临床状况、治疗模式和初始 VTE 后至 2013 年长期结果的重要信息来扩充和更新此管理数据库。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 VTE 复发和主要出血结局的长期风险，并开发可使用的临床风险分层工具预测复发性 VTE 和大出血。将临床和结果数据与管理数据相结合将创建一组可进行长期随访的 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，以在当代、现实世界的实践环境中解决最佳 VTE 管理问题。公共卫生相关性：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，会导致严重的发病率、死亡率和费用。该项目的目标是通过开发一个特征丰富的成人 VTE 队列来降低成人 VTE 相关的发病率和死亡率，并评估当前的治疗模式和 VTE 后的长期结果，该队列可用于回答有关以下方面的许多重要问题：在当代、现实世界的实践环境中实现最佳 VTE 管理。该项目将评估当前 VTE 的治疗模式，确定不良结果的风险因素，并开发临床适用的风险分层工具，以帮助预测复发性 VTE 和主要出血并发症。