Scientific Statement on Venous Thromboembolism Research Priorities

Cushman M, Barnes GD, Creager MA, et al.
Venous Thromboembolism Research Priorities: A Scientific Statement From the American Heart Association and the International Society on Thrombosis and Haemostasis. Circulation 2020;Jul 8:[Epub ahead of print].
  1. VTE remains a major cause of morbidity and mortality, affecting up to 1 million Americans and >700,000 Europeans annually.
  2. This scientific statement highlights future research priorities in VTE, developed by experts and a crowdsourcing survey across 16 scientific organizations.
  3. At the fundamental research level (T0), researchers need to:
    • Identify mechanistic differences between hemostasis and thrombosis.
    • Specify individual and interacting roles for cellular, biochemical, and biophysical (flow) functions and thrombogenesis.
    • Understand effects of vascular wall dysfunction and blood flow on thrombus formation.
    • Develop robust animal models of pulmonary embolism (PE) that mimic human disease.
    • Understand limitations and appropriate use of specific VTE preclinical models.
    • Distinguish mechanisms of in situ thrombosis versus embolization.
  4. At the human level (T1), there is a need to:
    • Develop imaging tools for diagnosis that characterize thrombus chronicity and embolic potential.
    • Identify new targets for anticoagulant therapies.
    • Combine imaging findings with biomarkers (circulating factors, genomics, etc.) to identify populations most likely to benefit from VTE prophylaxis or treatment.
    • Identify the role of novel biomarkers to predict VTE recurrence risk.
    • Explore the efficacy of VTE treatment strategies based on thrombus characteristics instead of duration.
  5. At the patient level (T2), research efforts are required to:
    • Identify patients most likely to benefit from catheter-based therapies in both PE and proximal deep vein thrombosis (DVT).
    • Explore the role of adjuvant therapies (e.g., statins, P2Y12 inhibitors) to prevent post-thrombotic syndrome.
    • Identify causes of breakthrough VTE despite adequate prophylaxis.
    • Improve prediction and understand clinical course of VTE in pediatric populations.
    • Define thresholds for VTE prophylaxis and appropriate dosing in those at risk of VTE, including pregnant patients.
  6. At the practice level (T3), researchers will need to:
    • Study methods to better implement VTE trial evidence into clinical practice, including both overuse and underuse of VTE-specific therapies.
    • Explore the role of the electronic medical record and population health tools intended to drive appropriate clinical care.
    • Study effectiveness of devices for PE and DVT treatment (vena cava filters, thrombus retrievers, etc.) using population-based registries.
    • Define the safety and efficacy of direct oral anticoagulant therapy in special populations.
    • Define the clinical and nonclinical impacts of thrombophilia testing in patients, their families, and the population at large.
  7. At the community and population level (T4), there is a need to:
    • Assess the impact of public awareness campaigns about VTE on disease detection, prevention, and treatment.
    • Conduct large population-based studies to explore biological and environmental underpinnings of VTE along with their patient-oriented nonthrombotic outcomes.
    • Perform population-based studies to examine patient-centered outcomes, including long-term symptoms, functional status, and the consequent effects on quality of life.
    • Define the impact of VTE on economic and health status measures across different populations.
    • Determine the effect of health care delivery on the variation in VTE outcomes.
  8. Large population-based cohort studies can elucidate the biological and environmental underpinnings of VTE and its complications.
  9. 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.
  10. Multidisciplinary approaches that integrate epidemiological, genomic, cellular, biochemical, and biophysical strategies to advance fundamental understanding and translate knowledge to patient care are needed to provide optimal insight to the field and to the patients, the ultimate beneficiaries of these efforts.

Clinical Topics: Anticoagulation Management, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism

Keywords: Anticoagulants, Diagnostic Imaging, Electronic Health Records, Hemostasis, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Patient Care, Postthrombotic Syndrome, Pregnancy, Public Health, Pulmonary Embolism, Quality of Life, Research, Secondary Prevention, Thrombophilia, Thrombosis, Vascular Diseases, Vena Cava Filters, Venous Thromboembolism

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