The U.S. Thrombosis and Hemostasis Centers pilot sites program

Abstract

Venous thromboembolism (VTE) is a common disorder associated with significant morbidity and mortality. Despite important advances in understanding the etiology of VTE, delivery of care to patients with thrombosis and thrombophilia is frequently incomplete and highly variable. A comprehensive model of health care has been used successfully to treat and prevent complications for people with hemophilia and other chronic disorders. The effectiveness of an integrated healthcare model for patients with all coagulation disorders has yet to be evaluated. The Division of Hereditary Blood Disorders of the Centers for Disease Control and Prevention (CDC) is collaborating with eight Thrombosis and Hemostasis Centers (pilot sites) to provide health-related services and conduct research directed toward the reduction or prevention of complications of thrombosis and thrombophilia. The initial objectives of the collaboration are to (1) determine the efficacy of integrated multidisciplinary care and prevention services for people with hemostatic disorders, (2) assess unmet needs for service delivery and identify outreach strategies to improve access to care, (3) develop effective messages aimed at disease management and prevention, and (4) foster the development of training programs to enhance provider skills for the delivery of patient care. To address these objectives, the investigators and CDC have developed and implemented a web-based patient registry to follow prospectively service allocation and patient outcomes. Funding for the program began in October 2001. All eight funded centers are affiliated with U.S. medical schools. Principal investigators at the centers are hematologists (five adult, two pediatric) or cardiologists. Faculty in obstetrics-gynecology, surgery, and multiple other specialties are integral to the model of care at the centers. Other critical components at the centers are clinical laboratory services, training programs, research networks, and education and outreach programs. From August 2003 to March 2006, over 2,600 patients were enrolled in the registry, accounting for a total of more than 5,000 visits to the centers. Immediate goals of the data collection at the centers are to characterize patients receiving care at centers and document the state of health services provided. Long-term goals are to evaluate prospectively clinical outcomes for patients receiving multidisciplinary care and prevention services at centers. The network of data collection across centers will facilitate future collaborative clinical and epidemiologic investigations and enhance collective expertise in hemostasis and coagulation disorders.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…This evaluation is perhaps best performed within an integrated multidisciplinary clinic by thrombophilia experts. 37 Timing of resumption of antithrombotic therapy postoperatively also is based on the relative risks of bleeding and thrombosis. In general, it is recommended that patients at low risk of bleeding initiate antithrombotic therapy 24 hours postoperatively, whereas those at high risk of bleeding wait for 48 to 72 hours.…”

Comparison of characteristics from White‐ and Black‐Americans with venous thromboembolism: A cross‐sectional study

“…The study setting was the seven centers (the University of Michigan Hemophilia and Coagulation Disorders Program, Ann Arbor, MI; the Thrombophilia Program, UNC, Chapel Hill, NC; the Michigan State University Comprehensive Center for Bleeding Disorders, East Lansing, MI; the Wayne State University, Detroit, MI; the Mountain States Regional Hemophilia and Thrombosis Center, Aurora, CO; the Duke Hemostasis and Thrombosis Center, Durham, NC; and the New Jersey Regional Hemophilia Program, UMDNJ-Robert Wood Johnson University Hospital, New Brunswick, NJ) within the CDC Thrombosis and Hemostasis Centers Research and Prevention Network [19] with substantial numbers of Black-American patients with VTE. Patients and/or their families attending one of the seven centers for medical care, or seen as an inpatient consult or referral, were approached by local center staff for study participation regardless of age, gender, or race.…”

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…[ This evaluation is perhaps best performed within an integrated multidisciplinary clinic by thrombophilia experts. 30 Incidence, Risk Factors, and Neurologic Outcome of Spinal Hematoma Spinal hematoma, defined as symptomatic bleeding within the spinal neuraxis, is a rare and potentially catastrophic complication of spinal or epidural anesthesia. The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with central neural blockade is unknown.…”