NHG-Richtlijnen
NHG-Standaard
M86
4.1
november 2023
september 2024
K. Hart-vaatstelsel

Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Richtlijnen beleid

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Voorlichting en advies

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Niet-medicamenteuze behandeling

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Medicamenteuze behandeling

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Controles

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Consultatie en verwijzing

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Diagnostiek en beleid bij oppervlakkige tromboflebitis

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Samenwerking en afstemming

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Achtergronden

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Begrippen

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Epidemiologie

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Etiologie

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Algemene etiologie

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Risicofactoren

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Pathogenese en prognose

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Richtlijnen diagnostiek

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Spoed

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Beslisregel en D-dimeer bij vermoeden van DVT

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Beslisregel en D-dimeer bij vermoeden van longembolie

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Randvoorwaarden bij het gebruik van beslisregels

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Randvoorwaarden bij gebruik D-dimeerbepaling

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POCT D-dimeerbepaling

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Compressie-echografie bij vermoeden van een DVT

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Evaluatie

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DVT: Eerstelijnsbeslisregel en D-dimeerbepaling (zie figuur 2)

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Longembolie: YEARS-algoritme en D-dimeerbepaling (zie figuur 3)

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Differentiaaldiagnose

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Richtlijnen beleid

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Behandeling DVT door de huisarts

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Geïsoleerde kuitvenetrombose

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Voorlichting en advies

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Niet-medicamenteuze behandeling

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Compressief zwachtelen

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Steunkousen

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Bij keuze voor steunkousen
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Medicamenteuze behandeling

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Algemene overwegingen bij antistollingsmedicatie

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Keuze tussen DOAC of VKA

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DOAC’s

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VKA’s (in combinatie met LMWH)

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Anticonceptie en hormoontherapie

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Behandelduur

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Acetylsalicylzuur

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Controles

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Eerste controle tijdens behandeling van DVT door de huisarts

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Tweede en derde controle tijdens behandeling van DVT door de huisarts

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Controle na het staken van de antistollingsbehandeling

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Onderzoek naar oorzaken van VTE

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Diagnostiek naar trombofilie
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Diagnostiek naar maligniteit
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Adviezen bij anticonceptie

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Adviezen bij reizen

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Consultatie en verwijzing

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Diagnostiek en beleid bij oppervlakkige tromboflebitis

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Diagnostiek

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Beleid

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Pijnbehandeling

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Keuze wel of geen antistolling

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Bij keuze voor behandeling met antistolling

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Controle en verwijzing

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Zwachtelen: korterekzwachtelmethode
NHG-werkgroep
Geersing GJ, Kessel LS, Poldervaart JM, Sival PPE, Smits PLM, Thissen LGP, Van den Donk M, Van Nieuwenhuijze FM, Van Osselen ECM, Wichers IM.
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