Cushman Mary, Barnes Geoffrey D, Creager Mark A, Diaz Jose A, Henke Peter K, Machlus Kellie R, Nieman Marvin T, Wolberg Alisa S
Department of Medicine Department of Pathology and Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT USA.
Frankel Cardiovascular Center University of Michigan Ann Arbor MI USA.
Res Pract Thromb Haemost. 2020 Jul 8;4(5):714-721. doi: 10.1002/rth2.12373. eCollection 2020 Jul.
Venous thromboembolism (VTE) is a major cause of morbidity and mortality. The impact of the Surgeon General's Call to Action in 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in VTE, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiologic causative mechanisms for the 50% of patients with unprovoked VTE and better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing VTE will allow tailoring of diagnostic and therapeutic approaches to individuals. At the patient level (T2), research efforts are required to understand how foundational evidence impacts care of patients (eg, biomarkers). New treatments, such as catheter-based therapies, require further testing to identify which patients are most likely to experience benefit. At the practice level (T3), translating evidence into practice remains challenging. Areas of overuse and underuse will require evidence-based tools to improve care delivery. At the community and population level (T4), public awareness campaigns need thorough impact assessment. Large population-based cohort studies can elucidate the biologic and environmental underpinings of VTE and its complications. To achieve these goals, funding agencies and training programs must support a new generation of scientists and clinicians who work in multidisciplinary teams to solve the pressing public health problem of VTE.
静脉血栓栓塞症(VTE)是发病和死亡的主要原因。鉴于该疾病对公共卫生的影响,2008年美国卫生局局长行动呼吁的影响低于预期。本科学声明强调了VTE未来的研究重点,这些重点由专家以及16个科学组织通过众包调查制定。在基础研究层面(T0),研究人员需要确定50%不明原因VTE患者的病理生物学致病机制,并更好地理解区分止血与血栓形成的机制。在个体层面(T1),诊断、治疗和预防VTE的新方法将使诊断和治疗方法能够因人而异。在患者层面(T2),需要开展研究工作以了解基础证据如何影响患者护理(如生物标志物)。新的治疗方法,如基于导管的治疗,需要进一步测试以确定哪些患者最有可能从中获益。在实践层面(T3),将证据转化为实践仍然具有挑战性。过度使用和使用不足的领域需要基于证据的工具来改善医疗服务。在社区和人群层面(T4),公众意识宣传活动需要进行全面的影响评估。基于大规模人群的队列研究可以阐明VTE及其并发症的生物学和环境基础。为实现这些目标,资助机构和培训项目必须支持新一代在多学科团队中工作的科学家和临床医生,以解决VTE这一紧迫的公共卫生问题。