Blood clots kill over 25,000 people in the UK each year through preventable venous thromboembolism (VTE)—more than breast cancer, AIDS, and road traffic accidents combined—yet half of these deaths occur after a hospital stay, and no one has measured the risk in nursing homes. This research tackles two gaps. First, doctors still underuse clot-preventing drugs in hospitals, and the scale of the problem in nursing homes is unknown. Second, after a first unprovoked deep-vein thrombosis, patients face up to a 10% annual recurrence risk once treatment stops, but clinicians cannot tell who needs lifelong anticoagulation. The team will run four workstreams: a nursing-home study to measure VTE rates; a trial comparing extended warfarin against no treatment after a first unprovoked clot; a qualitative study of barriers to using preventive drugs; and a cost-effectiveness analysis of different care models. If successful, the research could cut preventable deaths by identifying which nursing-home residents need prophylaxis and which patients require long-term therapy, while also providing the first UK cost data to guide NHS resource allocation.
View original technical description
Overarching aims To improve prevention and treatment of thrombosis in the NHS through a series of linked projects. BackgroundDeaths from venous thromboembolism (VTE) in the UK are greater than the combined total deaths from breast cancer, AIDS road traffic accidents and hospital acquired infections. A 2005 UK Health Select Committee report estimated that VTE caused over 25,000 preventable deaths annually with half due to hospital admission. There are no data for similar community populations, eg. nursing home residents. DVT can cause post-thrombotic syndrome, recurrent DVT and pulmonary embolus, with associated morbidity and mortality. Recurrence after first unprovoked DVT can be up to 10% per annum following treatment cessation irrespective of the duration of anticoagulation therapy. Clearly some patients need long-term anticoagulation however we are currently unable to identify this population. Importance of proposed research1. Thromboprophylaxis remains under-utilised within hospitals. We are yet to understand the scale of the problem within community nursing homes where risk factors are similar to those for hospital in-patients.2. There is a need for greater understanding of which patients require long term therapy following a first episode of VTE potentially reducing both VTE recurrence and the incidence of post thrombotic syndrome. These data will remain relevant with the advent of new anticoagulants.3. Education around the area of thromboprophylaxis will become increasingly relevant for primary and secondary care and an understanding of current knowledge as well as existing barriers to implementation of effective management strategies needs to be elucidated.4. There are no published data available on costs of delivery of VTE care in the UK. It is important therefore to identify different approaches to thromboprophylaxis using existing models of thromboprophylaxis for hospital in-patients and to explore through modelling different approaches to delivery of care for the treatment of VTE.Summary of Previous research by research team leading up to this proposalThe research team has an established record in the fields of primary care, thrombosis and haemostasis, cardiovascular disease, health economics, qualitative research and large pragmatic trials.Research PlansWS1: A prospective cohort observational study of consecutive nursing home individuals to determine incidence rates of VTE. WS2: A randomised controlled trial of extended warfarin treatment versus no treatment for the prevention of recurrent VTE and post-thrombotic syndrome in patients being treated for a first episode of unprovoked DVT.WS3: A qualitative study to to explore existing knowledge and barriers to implementing VTE thromboprophylaxis WS4: Determining the cost-effectiveness of thromboprophylaxis and the most cost-effective model of delivery of treatment for patients with VTE.Research TeamBirmingham and Oxford are founder members of the National School for Primary Care Research with extensive experience of conducting large community based trials. Programme ManagementA programme management board comprising the PI (Fitzmaurice), additional WS leads (Heneghan, Greenfield, Ward, Jowett), with additional support (eg; Holder, statistics, Murray, programme manager, Knight, lay person) will meet monthly to ensure satisfactory progress. Each WS will have additional project management with Trial Steering Committees and Data Monitoring Committees appointed as appropriate.Research EnvironmentPrimary and secondary care sites supported by the Primary Care Research Network for Central England and the Birmingham and Black Country Comprehensive Local Research Network. Anticipated outputs1. Understanding training needs for thrombosis risk assessment and provision of thromboprophylaxis at patient, practice, nursing home, hospital and commissioning level 2. Production of multidisciplinary educational material 3. Estimation for the first time of mortality from VTE in nursi
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know