Current research projects Dr. G-J. Geersing

Current research themes Julius primary care VTE group.

Project members:

  • Geert-Jan Geersing – project leader and general practitioner
  • Ruud Oudega – founding father of the group and general practitioner
  • Frans Rutten – general practitioner
  • Carl Moons – professor of clinical epidemiology
  • Arno Hoes – professor of clinical epidemiology and primary care
  • Janneke Hendriksen – PhD student and general practitioner trainee
  • Sander van Doorn – PhD student and general practitioner
  • Annelieke Kingma – PhD student and general practitioner trainee
  • Carline van den Dries – PhD student and general practitioner trainee

Research theme 1: Early diagnosis of VTE in primary care.

Pulmonary embolism (PE) is still one of the most commonly missed diagnoses in clinical medicine. In particular general practitioners have the difficult task to identify those patients with signs and symptoms that possibly can be attributed to PE. However, PE is still initially missed or overlooked in about 30% of all cases. In this research theme, we first aim to identify the type of patients in whom PE is more likely to be missed or overlooked, as well as try to identify the possible clinical consequences of missing a diagnosis.

Research theme 2: Optimize diagnostic strategies in suspected VTE in primary care.

In this research theme, we work further on improving already existing clinical decision rules for patients with suspected VTE, including the use of point-of-care D-dimer tests. An important and existing drawback with both clinical decision rules and D-dimer testing is that they become far less informative in the elderly: they always indicate an increased risk of VTE, even if this in fact is not true (no confirmed VTE after referral for imaging). Thus, there is a need to personalize or optimize these diagnostic tests and strategies, specifically for an elderly population. In fact, disease stratification is even more important in this frail population, as referral is not always an option and should only be truly considered if the risk of VTE indeed is truly increased. Within this theme, we also work on implementation strategies to increase the use of diagnostic strategies in suspected PE in primary care medicine.

Research theme 3: Treatment duration and use of direct oral anticoagulants in primary care.

An important missing link in knowledge of VTE is identify the optimal treatment duration after a first event. This in particular becomes problematic if the first event was unprovoked, as in this group the risk of recurrence is rather heterogeneous. Within this research theme we work on the development and validation of prediction models that accurately can predict the risk of a recurrent event. We, and others, hypothesize that this recurrence risk is a dominant determinant for assessing the treatment duration. Within this research theme we also evaluate the value and applicability of direct oral anticoagulants in primary care medicine.