Apenteng, Patricia N. (2020) Advances in the prevention of thrombosis : investigations into atrial fibrillation related stroke and venous thromboembolism. PhD thesis, University of Warwick.

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Abstract

This thesis brings together research undertaken by the author on prevention of two thrombotic disease conditions: atrial fibrillation (AF) related stroke and venous thromboembolism (VTE). The research presented is based on five publications from three studies using mixed methods. The first study was the UK component of a global prospective observational longitudinal cohort study of patients newly diagnosed with AF (GARFIELD-AF). Globally GARFIELD-AF recruited 52,080 patients newly diagnosed with AF, of which 3,879 were UK participants. Notably the unique objective published in the UK protocol to assess the performance of existing risk stratification tools in AF management led to the development of the GARFIELD-AF risk tool, an improved risk stratification tool that predicts mortality, stroke and bleeding in patients with AF. Further, the UK data indicated a substantial increase in the use of anticoagulants for the prevention of AF-related stroke following updates to AF management guidelines and the availability of non-vitamin K oral anticoagulants. The second study, an observational cohort study, determined for the first time the incidence of VTE in UK care homes. The VTE incidence in the study (0.71 to 2.48 per 100 person years) was substantial compared to known incidence in the community. This study contributed to national dialogue on VTE prevention and I was invited to present the findings at the All-Party Parliamentary Group on Thrombosis 2016 conference. The third study, a qualitative study, explored the prevention of hospital-associated thrombosis through interviews with patients and primary care professionals. The study identified a need for improved patient education on VTE, including how patients can recognise signs and symptoms of VTE. The related publication was instrumental in new recommendations on information giving on admission and discharge in the updated 2018 national VTE guidelines. Further research from gaps in knowledge identified in this thesis will complement ongoing initiatives and lead to improvements in the prevention of AF-related stroke and VTE in the UK and globally.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Atrial fibrillation -- Great Britain -- Complications, Cerebrovascular disease -- Great Britain -- Risk factors, Cerebrovascular disease -- Great Britain -- Prevention, Thromboembolism -- Great Britain -- Reporting, Thromboembolism -- Great Britain -- Prevention
Official Date:	March 2020
Dates:	Date Event March 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Fitzmaurice, David ; Dale, Jeremy
Format of File:	pdf
Extent:	ix, 107 leaves : illustrations (some color), charts (some color)
Language:	eng

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