Patients with lower leg cast immobilization or who had knee arthroscopy have an increased risk of venous thrombosis. Because of this increased risk, thromboprophylaxis was given to the majority of... Show morePatients with lower leg cast immobilization or who had knee arthroscopy have an increased risk of venous thrombosis. Because of this increased risk, thromboprophylaxis was given to the majority of these patients in the Netherlands, despite insufficient evidence for its effect. In this thesis, two large randomized controlled trials (including 1500 patients each, in which half of patients were randomized to prophylaxis with Low Molecular Weight Heparin (LMWH) and half of patients to no treatment) are described. Despite having an increased VTE risk, routine thromboprophylaxis with low dose LMWH did not decrease VTE risk in these patients. Therefore, we recommend no routine thromboprophylaxis with anticoagulants to these patients. Identification of high-risk patients and selective treatment of patients can be beneficial. Therefore, prediction models for the development of VTE in these patients were developed. The prediction models had good predictive value and were validated in two other studies. Hence, identification of high-risk patient can help to optimize prophylactic treatment: providing a higher dose or longer duration of anticoagulant treatment to patients with an additionally increased risk, whilst patients with a low risk will not be needlessly exposed to the burden and risk of anticoagulants. Show less
Venous thromboembolism is a common disease that can lead to potential fatal complications. The diagnosis and treatment of a first venous thromboembolism has been well studied, however the... Show moreVenous thromboembolism is a common disease that can lead to potential fatal complications. The diagnosis and treatment of a first venous thromboembolism has been well studied, however the diagnostic management and therapy of recurrent venous thromboembolism still have limitations. This thesis discusses a new imaging technique for recurrent deep venous thrombosis and the duration of treatment after a recurrent venous thromboembolism. It shows that Magnetic Resonance Direct Thrombus Imaging might be a potential diagnostic tool for the diagnostic management of recurrent venous thromboembolism. Furthermore the prognosis after a first deep vein thrombosis is discussed by means of recurrence and bleeding risks. Show less
The aims of this thesis were to investigate the efficacy and safety of outpatient treatment of patients with pulmonary embolism (PE) and to identify the best method for selection of PE patients for... Show moreThe aims of this thesis were to investigate the efficacy and safety of outpatient treatment of patients with pulmonary embolism (PE) and to identify the best method for selection of PE patients for outpatient treatment. Therefore, we performed the Hestia study and compared the selection of patients with the Hestia criteria to other methods for risk stratification, for example the simplified Pulmonary Embolism Severity Index and the method described in the European Society of Cardiology guidelines. Show less
