Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/3663629

In Collections

This item can be found in the following collections:

Stals, M.A.M. (2023)

The diagnostic management of suspected pulmonary embolism in special patient populations

Doctoral Thesis
Pulmonary embolism (PE) is a serious and sometimes life-threatening condition that refers to a blood clot that occludes the arteries of the lung. Despite all improvements over the past decades, diagnosing PE is still a difficult process due to the non-specific symptoms, which can frequently overlap with symptoms of other cardiopulmonary diseases. Currently recommended diagnostic strategies for suspected acute PE consist of standardized assessment of the clinical pre-test probability (CPTP) using validated clinical decision rules (CDRs) and D-dimer testing. PE is considered safely ruled out in patients with a non-high CPTP and a normal D-dimer test. Imaging tests as computed tomography pulmonary angiography (CTPA) are required in the case of a high CPTP and/or abnormal D-dimer test to confirm the diagnosis. The first part of this thesis describes the challenges of diagnosing PE in general and in specific clinically relevant patient subgroups. Moreover, this part evaluates the...Show morePulmonary embolism (PE) is a serious and sometimes life-threatening condition that refers to a blood clot that occludes the arteries of the lung. Despite all improvements over the past decades, diagnosing PE is still a difficult process due to the non-specific symptoms, which can frequently overlap with symptoms of other cardiopulmonary diseases. Currently recommended diagnostic strategies for suspected acute PE consist of standardized assessment of the clinical pre-test probability (CPTP) using validated clinical decision rules (CDRs) and D-dimer testing. PE is considered safely ruled out in patients with a non-high CPTP and a normal D-dimer test. Imaging tests as computed tomography pulmonary angiography (CTPA) are required in the case of a high CPTP and/or abnormal D-dimer test to confirm the diagnosis. The first part of this thesis describes the challenges of diagnosing PE in general and in specific clinically relevant patient subgroups. Moreover, this part evaluates the diagnostic performance of non-invasive diagnostic strategies for suspected PE in specific relevant patient subgroups. The second part of this thesis focuses on venous thrombotic complications in hospitalized patients with COVID-19.
Show less
Diagnosis
D-dimer
Diagnostic strategies
Pulmonary embolism
Venous Thromboembolism
Cancer patients
Pregnancy
Elderly
COVID-19
All authors
Stals, M.A.M.
Supervisor
Huisman, M.V.; Klok, F.A.
Committee
Eikenboom, H.C.J.; Cate, H. ten; Kamphuisen, P.W.; Beishuizen, E.D.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2023-11-23
ISBN (print)
9789463619134

Funding

Sponsorship
Financial support by the Dutch Heart Foundation for the publication of this thesis is gratefully acknowledged. Additional financial support for printing this thesis was kindly provided by Bayer Healthcare B.V., Chipsoft, Federatie van Nederlandse Trombosediensten, LEO Pharma B.V., Stago BNL B.V. and Trombosestichting Nederland.