Anja A van Houten

Publications (2)21.98 Total impact

• Source

  Available from: Hugo ten Cate

  Article: Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study.

  Renée A Douma, Inge C M Mos, Petra M G Erkens, Tessa A C Nizet, Marc F Durian, Marcel M Hovens, Anja A van Houten, Herman M A Hofstee, Frederikus A Klok, Hugo ten Cate, [......], van den Dool EJ, Kramer MH, Kaasjager K, Eikenboom HC, Heringhaus C, van Kralingen KW, Kroft LJ, de Roos A, Boomars K, Kruip MJ
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  ABSTRACT: Several clinical decision rules (CDRs) are available to exclude acute pulmonary embolism (PE), but they have not been directly compared. To directly compare the performance of 4 CDRs (Wells rule, revised Geneva score, simplified Wells rule, and simplified revised Geneva score) in combination with d-dimer testing to exclude PE. Prospective cohort study. 7 hospitals in the Netherlands. 807 consecutive patients with suspected acute PE. The clinical probability of PE was assessed by using a computer program that calculated all CDRs and indicated the next diagnostic step. Results of the CDRs and d-dimer tests guided clinical care. Results of the CDRs were compared with the prevalence of PE identified by computed tomography or venous thromboembolism at 3-month follow-up. Prevalence of PE was 23%. The proportion of patients categorized as PE-unlikely ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal d-dimer result, the CDRs excluded PE in 22% to 24% of patients. The total failure rates of the CDR and d-dimer combinations were similar (1 failure, 0.5% to 0.6% [upper-limit 95% CI, 2.9% to 3.1%]). Even though 30% of patients had discordant CDR outcomes, PE was not detected in any patient with discordant CDRs and a normal d-dimer result. Management was based on a combination of decision rules and d-dimer testing rather than only 1 CDR combined with d-dimer testing. All 4 CDRs show similar performance for exclusion of acute PE in combination with a normal d-dimer result. This prospective validation indicates that the simplified scores may be used in clinical practice. Academic Medical Center, VU University Medical Center, Rijnstate Hospital, Leiden University Medical Center, Maastricht University Medical Center, Erasmus Medical Center, and Maasstad Hospital.
  Annals of internal medicine 06/2011; 154(11):709-18. · 16.73 Impact Factor
• Article: The natural course of hemodynamically stable pulmonary embolism: Clinical outcome and risk factors in a large prospective cohort study.

  Mathilde Nijkeuter, Maaike Söhne, Lidwine W Tick, Pieter Willem Kamphuisen, Mark H H Kramer, Laurens Laterveer, Anja A van Houten, Marieke J H A Kruip, Frank W G Leebeek, Harry R Büller, Menno V Huisman
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  ABSTRACT: Pulmonary embolism (PE) is a potentially fatal disease with risks of recurrent venous thrombotic events (venous thromboembolism [VTE]) and major bleeding from anticoagulant therapy. Identifying risk factors for recurrent VTE, bleeding, and mortality may guide clinical decision making. To evaluate the incidence of recurrent VTE, hemorrhagic complications, and mortality in patients with PE, and to identify risk factors and the time course of these events. We evaluated consecutive patients with PE derived from a prospective management study, who were followed for 3 months, treated with anticoagulants, and underwent objective diagnostic testing for suspected recurrent VTE or bleeding. Of 673 patients with complete follow-up, 20 patients (3.0%; 95% confidence interval [CI], 1.8 to 4.6%) had recurrent VTE. Eleven of 14 patients with recurrent PE had a fatal PE (79%; 95% CI, 49 to 95%), occurring mostly in the first week after diagnosis of initial PE. In 23 patients (3.4%; 95% CI, 2.2 to 5.1%), a hemorrhagic complication occurred, 10 of which were major bleeds (1.5%; 95% CI, 0.7 to 2.7%), and 2 were fatal (0.3%; 95% CI, 0.04 to 1.1%). During the 3-month follow-up, 55 patients died (8.2%; 95% CI, 6.2 to 10.5%). Risk factors for recurrent VTE were immobilization for > 3 days and being an inpatient; having COPD or malignancies were risk factors for bleeding. Higher age, immobilization, malignancy, and being an inpatient were risk factors for mortality. Recurrent VTE occurred in a small percentage of patients treated for an acute PE, and the majority of recurrent PEs were fatal. Immobilization, hospitalization, age, COPD, and malignancies were risk factors for recurrent VTE, bleeding, and mortality. Close monitoring may be indicated in these patients, precluding them from out-of-hospital start of treatment.
  Chest 03/2007; 131(2):517-23. · 5.25 Impact Factor