Circulation. 2020 Aug 11;142(6):e85-e94. doi: 10.1161/CIR.0000000000000818. Epub 2020 Jul 8.
Venous thromboembolism is a major cause of morbidity and mortality. The impact of the US Surgeon General's in 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in venous thromboembolism, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiological causative mechanisms for the 50% of patients with unprovoked venous thromboembolism and to better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing venous thromboembolism 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 biological and environmental underpinnings of venous thromboembolism 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 venous thromboembolism.
静脉血栓栓塞症是发病率和死亡率的主要原因。考虑到这种疾病对公众健康的影响,2008 年美国外科医生总干事的倡议的影响低于预期。本科学声明强调了静脉血栓栓塞症未来的研究重点,由专家和 16 个科学组织的众包调查制定。在基础研究层面(T0),研究人员需要确定 50%无诱因静脉血栓栓塞症患者的病理生物学致病机制,并更好地了解区分止血和血栓形成的机制。在人体层面(T1),用于诊断、治疗和预防静脉血栓栓塞症的新方法将允许针对个体定制诊断和治疗方法。在患者层面(T2),需要研究如何理解基础证据对患者护理的影响(例如,生物标志物)。新的治疗方法,如基于导管的治疗方法,需要进一步的测试来确定哪些患者最有可能受益。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将需要基于证据的工具来改善护理的提供。在社区和人群层面(T4),公众意识宣传活动需要进行彻底的影响评估。基于人群的大型队列研究可以阐明静脉血栓栓塞症及其并发症的生物学和环境基础。为了实现这些目标,资助机构和培训计划必须支持新一代科学家和临床医生,他们在多学科团队中合作,解决静脉血栓栓塞症这一紧迫的公共卫生问题。