Deep vein thrombosis : diagnostic and prognostic challenges

Abstract

This

thesis about deep vein thrombosis consists of two parts. The studies described

in the first part of this thesis aimed to improve the diagnostic management of

deep vein thrombosis (DVT) in general, and in diagnostic challenging circumstances specifically. First, a new diagnostic safety threshold for all future diagnostic studies in deep vein thrombosis was established, adjusted to the disease prevalence in the study population. Thereafter a new simpler clinical decision rule, as first step in the diagnostic management of DVT was designed, selecting 4 items of the Wells rule. In the following chapter’s, studies using the MRI technique: Magnetic Resonance Direct Thrombus Imaging (MRDTI) were described. This is a non-contrast enhanced MRI technique by which a thrombus can be visualized directly. This technique was applied to diagnose DVT in challenging circumstances: ipsilateral recurrent DVT, DVT in pregnant woman and upper extremity DVT. The second part of this thesis describes studies that aimed to improve the prognosis of DVT by evaluation of the persistence to prescribed therapy and predictors of the development of post thrombotic syndrome (PTS).