Hemostasis and Thrombosis Research Track
This is a 1-2 year experience available to a 2nd/3rd year Fellows in Hematology/Oncology interested in training in thrombosis, hemostasis and/or vascular disease epidemiology. Other types of trainees in other programs are also welcome to participate. The program is designed by the trainee and their mentor to meet the trainee's goals using any elements herein.
Mary Cushman, MD, MSc, Professor of Medicine and Pathology
Chris Holmes, MD,
Neil Zakai, MD, MSc, Associate Professor of Medicine and Pathology
Steven Ades, MD, MSc. Associate Professor of Medicine
Timothy Plante, MD, MHS. Assistant Professor of Medicine
Pathology and Laboratory Medicine
Michael Lewis, MD, Associate Professor of Pathology
Others as appropriate for specific projects.
To train fellows in research via projects in hemostasis, thrombosis and related topics. Projects relate to cardiovascular disease epidemiology or treatment/prevention, including arterial and venous disease, quality, implementation and outcomes research, or basic or translational aspects of hemostasis. Clinical/translational research emphasizes cancer and thrombosis. Goals are tailored to each candidate's specific research project and career path.
Possible Training Components:
- Clinical: Evaluation and management of patients with, or at risk of, venous thrombosis. Genetic counseling and treatment in those at high risk.
- Research methods: biostatistics and epidemiologic or clinical study design. Electronic health record / national hospital data-based health services research.
- Outcomes Research: Risk assessment tools, quality, and implementation science.
- Molecular epidemiology research: evaluation of phenotypic and genetic risk factors. Learn the role of this type of research for hypothesis formation about disease pathogenesis and public health applications.
- Clinical Trials: participate in ongoing trials or design and implement a trial.
- Masters or
PhDprogram in Clinical and Translational Research, Master in Public Health.
- Operational aspects of a core laboratory for clinical and epidemiological research:
- methods for managing biological samples in multicenter studies
- clinical laboratory principles including quality control and assurance
- assay methods: ELISA, chromogenic, automated coagulation tests, nephelometry, DNA analysis, multiplex technology, aptamer-based assays, other novel assay development.
- Peer Review. Learn peer review from experts. Dr. Cushman is a journal editor (Research and Practice in Thrombosis and Haemostasis) and all faculty review extensively or serve on editorial boards. Dr. Plante is Editor of Wiki Journal Club.
- Human Subjects research policy education.
- The Laboratory for Clinical Biochemistry Research (LCBR) has over 40 ongoing independent and collaborative multi-site research projects focused on vascular diseases including heart disease, stroke, and venous thrombosis. Other interests are in obesity, diabetes, aging, dementia, frailty, and HIV. We use a wide variety of assays in population and family-based research settings particularly in the areas of coagulation, fibrinolysis, thrombosis, inflammation, and immune system function, including cell manipulation assays. The main purposes are hypothesis formation about
pathogenesisof vascular disease, but others include public health applications and clinical trials. Over 3 million human biological samples are stored in the biorepository for use in research. Projects usually involve collaborations with investigators at other institutions. Office space at the LCBR and use of a computer with needed software, are provided. PI's include Drs. Tracy, Cushman, Zakai, Lewis, and Jenny.
- Cardiovascular Research Institute (CVRI). This institute spans the spectrum of research on cardiovascular diseases, ranging from research in cardiac rehabilitation to gene therapy and cardiomyopathy. The program includes events that integrate programs across the institution, an active early career advisory committee, high profile visiting professors, and ample travel grants for trainees. Dr. Cushman is a board member and Dr. Tracy is a CVRI Distinguished Investigator.
- The Thrombosis and Hemostasis Program in the Division of Hematology-Oncology (THP) provides a clinical population of patients, primarily with venous thrombosis but also with arterial thrombosis (especially stroke). Clinical-translational research projects and trials can be developed. Hospital- and clinic-based outcomes research projects related to quality improvement and implementation science, or other topics, can be pursued. Current emphasis is on VTE prevention in cancer, VTE risk assessment in medical inpatients and optimizing treatment of VTE. PI's include Drs. Cushman, Holmes, Zakai, and Plante.
Funding may be pursued from the Vermont Cancer Center, American Society of Hematology, American Society of Clinical Oncology, American Heart Association, Hemostasis and Thrombosis Research Society or other sources.
Experiences for Fellows in Hematology-Oncology
- Optional one-year continuity clinic in Thrombosis and Hemostasis.
- Attendance at meetings
- Laboratory Meetings of the lab(s) where the fellow is affiliated.
- Monthly Interdisciplinary Vermont Vascular Medicine Conference
- Monthly Vermont Emerging Research in Cardiovascular Science Conference
- Thrombosis and Hemostasis Program weekly Clinical Case Conference
- At least weekly meeting with
- Quarterly Thrombosis and Hemostasis Program – Maternal Fetal Medicine Service Case Conference.
- Quarterly Multidisciplinary Stroke Conference
- Networking career development events of the CVRI
- Research Project: The Fellow will identify a research mentor in their first fellowship year by meeting each program faculty member. It is expected that they carry out a project and publish the results, including at least one presentation at a national meeting and one published manuscript. Fellows are encouraged to write a grant proposal under the guidance of their mentor.
- Often the fellow will spend their full third year, apart from the required continuity clinic, working on their research project.
- It is recommended, but not required, that fellows spend
a fourthyear to optimize full-time research training.
Experiences for Trainees at Other Levels
Determined on an individual basis depending on the level of the trainee and the project undertaken.
Recent Trainee Publications
- Landry KK, Alexander KS, Zakai NA, Judd SE, Kleindorfer DO, Howard VJ, Howard G, Cushman M. Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. J Thromb Haemost 2017;15:21-7.
- Cahill CR, Howard G, McClure LA, Zakai NA, Jenny NS, Kissela BM, Safford MM, Howard VJ, Cushman M. C-reactive protein and stroke risk in blacks and whites: the REasons for Geographic and Racial Differences in Stroke Study. Submitted.
- Cahill CR, Leach JM, McClure LA, Irvin MR, Zakai NA, Naik R, Unverzagt F, Wadley VG, Hyacinth HI, Manly J, Judd SE, Winkler C, Cushman M. Sickle cell trait and risk of cognitive impairment: the Reasons for Geographic and Racial Differences in Stroke Cohort. Submitted.
- Gillett SR, Boyle RH, Zakai NA, McClure LA, Jenny NS, Cushman M. Validating laboratory results in a national observational cohort study without field centers: the Reasons for Geographic and Racial Differences in Stroke Cohort. Clin Biochem 2014;47:243-6.
- Engbers MJ, Karasu A, Blom JW, Cushman M, Rosendaal FR, van Hylckama Vlieg A. Clinical features of venous insufficiency and risk of venous thrombosis in older people. Br J Haematol 2015;171:417-23.
- Gillett SR, Thacker EL, Letter AJ, McClure LA, Wadley VG, Unverzagt FW, Kissela MB, Kennedy R, Glasser SP, Levine DA, Cushman M. Correlates of incident cognitive impairment in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study case-cohort sample. Clin Neuropsychol 2015;15:1-21.
- Durda P, Sabourin J, Lange EM, Nalls MA, Mychaleckyj JC, Jenny NS, Li J, Walston J, Harris TB, Psaty BM, Valdar W, Liu Y, Cushman, Reiner AP, Tracy RP, Lange LA. Plasma levels of sIL2 receptor Î±: associations with clinical cardiovascular events and genome-wide association scan. Arterioscler Thromb Vasc Biol 2015;35:2246-53.
- Cheung KL, Zakai NA, Folsom AR, Kurella Tamura M, Peralta CA, Judd SE, Callas PW, Cushman M. Measures of kidney disease and the risk of venous thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Am J Kidney Dis. 2017;70:182-90.
- Bryan LJ, Callas P, Criqui MH, Cushman M. Higher soluble P-selectin is associated with chronic venous insufficiency: the San Diego Population Study. Thromb Res 2012;130:716-19.
- Bryan LJ, Zakai NA. Why is my patient anemic? Hematol Oncol Clin North Am. 2012;26(2):205-30.
- Sharma D, Brummel-Ziedins KE, Bouchard BA, Holmes CE. Platelets in tumor progression: a host factor that offers multiple potential targets in the treatment of cancer. J Cell Physiol 2014;229:1005-15.
- Lal I, Dittus K, Holmes CE. Platelets, coagulation, and fibrinolysis in breast cancer progression. Breast Can Res 2013:15;207.
- Adams NB, Lutsey PL, Folsom AR, Herrington DH, Sibley CT, Zakai NA, Ades S, Burke GL, Cushman M. Statin therapy and levels of hemostatic factors in a healthy population: the Multi-Ethnic Study of Atherosclerosis. J Thromb Haemost 2013;11:1078-84.
- Suzuki T, Voeks J, Zakai NA, Jenny NS, Brown TM, Safford MM, LeWinter M, Howard G, Cushman M. Metabolic syndrome, C-reactive protein and mortality in U.S. blacks and whites: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Diabetes Care. 2014; 37: 2284-90.
- Alexander KS, Zakai NA, Gillett S, McLure LA, Wadley V, Unverzagt F, Cushman M. ABO blood type, factor VIII and incident cognitive impairment in the REGARDS cohort. Neurology 2014;30:1271-6.
- Olson NC, Cushman M, Lutsey PL, McClure LA, Judd S, Tracy RP, Folsom AR, Zakai NA. Inflammation markers and incident venous thromboembolism: the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. J Thromb Haemost 2014;12:1993-2001.
- Olson NC, Cushman M, Judd SE, McClure LA, Lakoski SG, Folsom AR, Safford MM, Zakai NA. American Heart Association's Life's Simple 7 and Risk of Venous Thromboembolism: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Am Heart Assoc 2015;4:
- Olson NC, Butenas S, Lange E, Lange LA, Jenny NS, Walston J, Cushman M, Tracy RP, Reiner AP. Coagulation factor XII genetic variation, ex vivo thrombin generation, and stroke risk in the elderly: results from the Cardiovascular Health Study. J Thromb Haemost 2015;13:1867-77.
- Olson NC, Doyle MF, de Boer IH, Huber SA, Jenny NS, Kronmal RA, Psaty BM and Tracy RP. Associations of Circulating Lymphocyte Subpopulations with Type 2 Diabetes: Cross-Sectional Results from the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One. 2015;10: e0139962.
- Winters J, Callas P, Repp AB, Cushman M, Zakai NA. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. J Thromb Haemost 2015;13:2155-60.
- Winters J, Morris CS, Holmes C, Lewis P, Bhave AD, Najarian KE, Shields JT, Charash W, Cushman M. A multidisciplinary quality improvement program increases inferior vena cava filter retrieval rates. Vasc Med 2017;22:51-6.
- Olson NC, Cushman M, Judd SE, Kissela BM, Safford MM, Howard G, Zakai NA. Associations of coagulation factors IX and XI levels with incident coronary heart disease and ischemic stroke: the REGARDS study. J Thromb Haemost 2017;15:1086-94.
Recent Faculty Publications
- Ades S, Kumar S, Alam M, Goodwin A, Weckstein D, Dugan M, Ashikaga T, Evans M, Verschraegen C, Holmes CE. Tumor Oncogene (KRAS) Status and Risk of Venous Thrombosis in Patients with Metastatic Colorectal Cancer. J Thromb Haemost 2015;13:998-1003.
- Cushman M, Creager MA. Improving awareness and outcomes related to venous thromboembolism. JAMA 2015;314:1913-4.
- Bell EJ, Lutsey PL, Basu S, Cushman M, Heckbert SR, Lloyd-Jones DM, Folsom AR.
Lifetimerisk of venous thromboembolism in two cohort studies. Am J Med 2016; 129: 339. e19-26
- Cushman M, O'Meara ES, Heckbert SR, Zakai NA, Rosamond W, Folsom AR. Body size measures, hemostatic and inflammatory markers, and risk of venous thrombosis: the Longitudinal Investigation of Thromboembolism Etiology. Thromb Res 2016;144:127-32.
- CHARGE Consortium Hematology Working Group. Meta-analysis of rare and common exome chip variants identifies S1PR4 and other loci influencing blood cell traits. Nat Genet 2016;48:867-76.
- Tejiram S, Brummel-Ziedins KE, Orfeo T, Mete M, Desale S, Hamilton BN, Moffatt LT, Mann KG, Tracy RP, Shupp JW. In-depth analysis of clotting dynamics in burn patients. J Surg Res. 2016;202(2):341-51.
- Cushman M, Callas PW, McClure LA, Unverzagt FW, Howard VJ, Gillett SR, Thacker EL, Wadley VG. N-terminal pro-B-type natriuretic peptide and risk of future cognitive impairment in the REGARDS cohort. J Alzheimers Dis 2016;54:497-503.
- Natriuretic Peptides Studies Collaboration. Natriuretic peptides and integrated risk assessment for cardiovascular disease: individual-participant data meta-analysis of 40 prospective studies. Lancet Diabetes Endocrinol 2016;4:840-9.
- McLean K, Cushman M. Venous thromboembolism
andstroke in pregnancy. Am Soc Hematol Educ Program 2016:243-50.
- Holmes CE, Levis JE, Schneider DJ, Bambace NM, Sharma D, Lal I, Wood ME, Muss HB. Platelet phenotype changes associated with breast cancer and its treatment. Platelets 2016;27:703-11.
- Plante TB, Urrea B, MacFarlane ZT, Blumenthal RS, Miller ER 3rd, Appel LJ, Martin SS. Validation of the Instant Blood Pressure smartphone app. JAMA Intern Med 2016;176:700-2.
- Mahmoodi BK, Cushman M, Naess IA, Allison MA, Bos WJ, Braekkan SK, Cannegieter SC, Gansevoort RT, Gona PN, Hammerstrom J, Hansen JB, Heckbert S, Holst AG, Lutsey PL, Manson JE, Martin LW, Matsushita K, Meijer K, Lakoski SG, Overvad K, Prescott E, Puurunen M, Rossouw JE, Sang Y, Severinsen MT, ten Berg J, Folsom AR, Zakai NA. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual-level data meta-analysis of prospective studies. Circulation 2017;135:7-16.
- Zakai NA, McClure LA, Judd SE, Kissela B, Howard G, Safford MM, Cushman M. D-dimer and risk of stroke and coronary heart disease: the Reasons for Geographic and Racial Differences in Stroke (REGARDS). Thromb Haemost 2017;117:618-24.
- Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, et al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 2017;135:e146-603.
- Doyle MF, Tracy RP, Parikh MA, Hoffman EA, Shimbo D, Austin JH, Smith BM, Hueper K, Vogel-Claussen J, Lima J, Gomes A, Watson K, Kawut S and Barr RG. Endothelial progenitor cells in chronic obstructive pulmonary disease and emphysema. PLoS One. 2017;12:e0173446.
- Cushman M. Hello Research and Practice in Thrombosis and Haemostasis. Res Pract Thromb Haemost 2017;1:5.
- Takeki Suzuki, MD. Cardiology Fellow / Masters of Public Health (Johns Hopkins University). Funding: PI grant. Inflammation, metabolic syndrome
andrisk of congestive heart failure in the elderly. 2007-9. 3 papers. Current Position: Assistant Professor of Medicine, Cardiovascular Medicine, University of Mississippi. Mentor: Cushman
- Nadia Bambace, MD, Internal Medicine Residency Research. Impact of ADP on VEGF and endostatin release from platelets. Funding: American Society of Hematology Trainee Research Award. 2006-7. 1 paper. Harriet P. Dustan Award for Residency Research. Current Position: Assistant Professor, Division of Hematology and Medical Oncology, Stem Cell Transplant Program, University of Montreal. Mentor: Holmes
- Richard Zinke. Medical Student. Factor VIII/von Willebrand factor concentrate for treatment of life-threatening epistaxis in Glanzmann's thrombasthenia. 2009 National medical students competition award for clinical research, American College of Physicians. 2008-9. 1 paper. Current Position: Private practice
hematology oncology, Tualatin, OR. Mentor: Holmes
- Locke Bryan, MD. Resident in Internal Medicine. P-selection and Risk of Chronic Venous Disease. 2010-12. Funding: American Society of Hematology Research Training Award. 1 abstract, 1 paper, 1 review article. American Society of Hematology Trainee Research Award. Current Position: Assistant Professor of Medicine, Hematology Oncology, Augusta University, Augusta, GA. Mentor: Cushman
- N. Brad Adams, MD, Fellow in Hematology-Oncology. Association of Statin Use with Hemostasis Factors: the Multi-Ethnic Study of Atherosclerosis. 2010-12. Funding:
departmental. 1 abstract. 1 paper. Current Position: Private Practice Hematology-Oncology, Boise ID. Mentor: Cushman
- Jagoda Jasielec, M.D. Internal Medicine Resident. The impact of aspirin therapy on angiogenic protein levels in women receiving tamoxifen therapy. 2011-12. 1 abstract. Current Position: Clinical Assistant Professor, University of Chicago, NorthShore Medical Group, Evanston, IL. Mentor: Holmes
- Catherine Mygatt. Medical Student. Funding: Departmental - Pathology Student Fellowship. Fatal venous thromboembolism in medical patients. 2011-12. 1 poster. Current position: Family Medicine Resident, Lawrence (MA) Family Medicine. Mentor: Zakai.
- Sarah Gillett, Ph.D. in Clinical Translational Science, 2008-15. Inflammation, Hemostasis and the Risk of Cognitive Decline. Funding: NHLBI T32 Hemostasis and Thrombosis Training Grant. Current Position: Internal Medicine Resident, University of Vermont. Mentor: Cushman
- Deva Sharma, M.D. Internal Medicine Resident. The impact of platelet activation on endothelial cell gene expression and Platelet TGFB Release following agonist stimulation in patients with malignancy. Funding: ASH Trainee Research Award 2012. 1 paper. Current position- Post-doctoral Fellow in Hematology Research, University of Pittsburgh. Mentor: Holmes.
- Inder Lal, M.D. Postdoctoral Fellow then Hematology-Oncology Fellow. Platelet proteins in patients with breast cancer. 2012-16. Funding: Vermont Cancer Center. Current Position: Private practice hematology-oncology, Dyson Center for Cancer Care, Poughkeepsie, NY. Mentor: Holmes and Ades.
- John Winters, MD. Hematology-Oncology Fellow. Hospital-acquired upper extremity VTE in medical inpatients. Bleeding Risk in Medical Inpatients. IVC filter retrieval optimization. 3 abstracts. 2 papers. 2012-14. Current Position: Private practice hematology-oncology, Portland, ME. Mentors: Zakai and Cushman
- Samuel Merrill. MD. Internal Medicine Resident. Community and Hospital-acquired infections and risk of hospital-acquired venous thromboembolism. 2013-15. 1 abstract. Current position: Hematology / Oncology Fellow Johns Hopkins University Mentor: Zakai
- Damon Houghton, MD. Internal Medicine Resident. Validation of a venous thrombosis risk prediction model for medical inpatients. 1 abstract. 2013-15. Current Position: Vascular Medicine Fellow, Mayo Clinic, Rochester, MN. (after Hematology Fellowship, University of North Carolina, Chapel Hill). Mentor: Zakai
- Zubin Agarwal, MD, MPH. Internal Medicine Resident. Galectin-3 and Risk of Stroke. 2013-15. 1 abstract. Current Position: Electrophysiology Fellow, Beth Israel Deaconess Medical Center, Boston MA. Mentor: Cushman.
- Markus Degirmenci, MD. Internal Medicine Resident. Dehydroepiandrosterone Sulfate and the Risk of Stroke. 2013-15. 1 abstract. Current Position: Hospitalist, University of Vermont Medical Center. Mentor: Cushman.
- Kara K. Landry. Medical Student. Biomarkers of Stroke Symptoms in a Biracial Cohort. 2014-15. 1 abstract. 1 paper. Current Position. Resident in Medicine, University of Vermont. Mentor: Cushman.
- Santosh Kumar, MD. Post-Doctoral Fellow. 2013-14. Tumor Oncogene (KRAS) Status and Risk of Venous Thrombosis in Patients with Metastatic Colorectal Cancer. Current Position:
Hematology OncologyFellow, University of Rochester, Wilmot Cancer Institute. Mentor: Ades.
- Kristine Alexander, Ph.D. Postdoctoral Fellow. Hemostasis, Stroke and Cognitive Impairment. 2012- Funding: NHLBI T32 HL07594. Hemostasis and Thrombosis Training Grant. 2 abstracts 2 papers. Current Position: Health Policy Analyst, Cambia Health Solutions, Portland, OR. Mentor: Cushman
- Marissa J. Engbers, MD. Ph.D. in Epidemiology, Leiden University 2008-15. Age and Thrombosis: Acquired and Genetic Risk Factors in the Elderly. Funding:
FondationLeducq Transatlantic Network of Excellence in Cardiovascular Research. Current Position. Private practice medicine. Leiden, the Netherlands. Mentor: Cushman
- Mathew Lebow, BA. Post-baccalaureate student. Thrombocytopenia in Hospitalized Medical Patients. Current Position: Medical Student, University of Vermont. 2 abstracts. Mentor: Zakai.
- Peter Durda, BS. Ph.D. in Clinical Translational Science. 2012-17. Innate and Adaptive Immunity in Atherosclerosis. 3 abstracts 1 paper. Mentor: Tracy.
- Christina Cahill, MPH. Medical Student. C-reactive Protein and Stroke Risk in African-Americans and Whites. Epidemiology of sickle cell trait. 1 abstract. Mentor: Cushman.
- Kara K. Landry, MD. Internal Medicine Resident. N-terminal pro-B-type Natriuretic Peptide and Stroke Risk. 1 abstract. 2015-present.
Universityof Vermont. Mentor: Cushman.
- Katharine Cheung, MD. Ph.D. Student, Clinical and Translational Science. Chronic Kidney Disease and Venous Thrombosis. 2 papers, 1 abstract. 2013-present. Mentor: Cushman.
- Nels Olson, Ph.D. Postdoctoral Fellow. Immunity, Hemostasis, and Atherosclerosis. 2011-present. Funding: NHLBI T32 Hemostasis and Thrombosis Training Grant then K99-R00 grant. 8 papers. Mentor: RP Tracy.
- Daniel Douce, MD. Postdoctoral Fellow then Hematology-Oncology Fellow. Epidemiology of Venous Thrombosis. 2014-present. 3 abstracts, 1 manuscript. Funding: Lake Champlain Cancer Research Organization. Mentor: Zakai
- Bhargavi Pulluri, MD. Fellow, Hematology-Oncology. Venous Thrombosis in Colorectal Cancer: analysis of SEER Data. 2015-18. 1 abstract. Mentor: Ades.
- Mathew Lebow, BA. Medical student. Epidemiology of Hospital-Acquired Thrombocytopenia in Cancer Patients. Funding: Northern New England Clinical Oncology Society. 1 abstract. Mentor: Zakai.
- Hank Ng, MD. Internal Medicine Resident. Anticoagulant Drug Interactions in Cancer Patients. Mentor: Holmes
- Purva Sharma, MD. Hematology Oncology Fellow. Thrombosis in Lung Cancer Patients Receiving Immunotherapy. 2017-18. Mentor: Holmes
- Heather Wright, MD. Internal Medicine Resident. Venous Thromboembolism Increases the Health Care Burden in Patients with Glioma. 2017-18. 2 abstracts. Co-Mentors: Holmes, Thomas
- Harshal Athalye. Medical Student. Prior Venous Thrombosis and the Risk of Venous Thrombosis in Older People. 2017-present. Mentor: Cushman
- Juan Conde, Ph.D. Medical Student. Smoking, Biomarkers and Stroke Risk. 2018-present. Mentor: Cushman
- Jordan Munger, BA. Medical Student. Television watching and VTE risk. 2018-present. Mentor: Zakai