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Title: Personalised approaches to antithrombotic therapies : insights from linked electronic health records
Author: Pasea, Laura
ISNI:       0000 0004 7659 7835
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2018
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Antithrombotic drugs are increasingly used for the prevention of atherothrombotic events in cardiovascular diseases and represent a paradigm for the study of personalised medicine because of the need to balance potential benefits with the substantial risks of bleeding harms. To be effective, personalised medicine needs validated prognostic risk models, rich phenotypes, and patient monitoring over time. The opportunity to use linked electronic health records has potential advantages; we have rich longitudinal data spanning patients' entire journey through the healthcare system including primary care visits, clinical biomarkers, hospital admissions, hospital procedures and prescribed medication. Challenges include structuring the data into research-ready format and accurately defining clinical endpoints and handling missing data. The data used in this thesis was from the CALIBER platform: linked routinely-collected electronic health records from general practices, hospitals admissions, myocardial infarction registry and death registry for 2 million patients in England from 1997 to 2010. In this thesis I (1) developed comprehensive bleeding phenotypes in linked electronic health records, (2) assessed the incidence and prognosis of bleeding in atrial fibrillation and coronary disease patients in England, (3) developed and validated prognostic models for atherothrombotic and bleeding events in stable myocardial infarction survivors pertaining to the benefits and harms of prolonged dual antiplatelet therapy, (4) assessed the predictors and outcomes associated with time in therapeutic range for patients treated with oral anticoagulants (5) assessed the predictive value of novel measures of international normalised ratio control in patients treated with oral anticoagulants for atherothrombotic and bleeding outcomes. Taken together these findings offer researchers scalable methodological approaches, that may be applied to other diseases and treatments with crucial benefits and harms considerations, and demonstrates how records used in clinical practice maybe harnessed to improve treatment decisions, monitoring and overall care of a cardiovascular disease population treated with a class of drugs.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available