Date of Award
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Program
Health Outcomes and Policy Research
Track
Health Services Research
Research Advisor
James Bailey, MD
Committee
Jane Hankins, MD; Justin Gatwood, PhD; Kenneth Ataga, MD; Min Zhang, PhD
Keywords
Longitudinal study, Real-world evidence, Risk factors, Survival analysis
Abstract
Sickle cell disease (SCD) is an inherited disease characterized by sickle-shaped red blood cells that can slow or block blood flow. It affects about 100,000 people in the United States, and occurs more commonly in people of African descent. SCD is considered as a hypercoagulable state and venous thromboembolism (VTE) is a serious disease-specific complication. However, there have been limited real-world studies on VTE in SCD patients. This work aims to provide a comprehensive assessment of the risk factors and treatment of VTE in adults with SCD by using longitudinal real-world data. First, a retrospective cohort study on 30-day readmission was conducted to give a general understanding of the treatment of SCD. It was found that SCD patients were at high risk of readmission, and younger adults had higher risk than older adults. The risk factors vary significantly by age. These findings suggest that multifaceted, age-specific interventions are needed to improve the clinical outcomes of SCD patients. Second, the treatment patterns of pharmacological anticoagulation in adults with SCD was studied by using a retrospective, repeated cross-sectional design. The results may contribute to the optimal selection of regimens or dosing and informed decision making on anticoagulant utilization in routine care. Third, the incidence of VTE and its associated risk factors and clinical outcomes were examined. Several SCD-related complications and treatments were found to be significantly associated with VTE. Landmark survival analysis demonstrated that early management of VTE may improve the overall survival of SCD patients.
ORCID
0000-0003-3215-8657
DOI
10.21007/etd.cghs.2024.0669
Recommended Citation
Chen, Ming (0000-0003-3215-8657), "Real-world Pharmacological Anticoagulation and Clinical Outcomes of Venous Thromboembolism in Adults with Sickle Cell Disease" (2024). Theses and Dissertations (ETD). Paper 689. http://dx.doi.org/10.21007/etd.cghs.2024.0669.
https://dc.uthsc.edu/dissertations/689
Declaration of Authorship
Included in
Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Hemic and Lymphatic Diseases Commons, Quality Improvement Commons
