PhD defence C.S.B. (Caroline) Veen

Clinical studies on patients with bleeding symptoms have consistently shown that in the majority of these patients no bleeding disorder can be diagnosed. These patients are classified as having Bleeding of Unknown Cause (BUC). Optimal management for prevention and treatment of bleeding in BUC patients is unclear, as only limited evidence on effective and adequate management strategies is available. Global screening tests which assess the overall haemostatic potential, may be of value in screening and diagnosis of BUC. In our prospective cohort study we included 181 patients referred for analysis of a bleeding tendency and 76 healthy controls. Our findings, based on these global screening tests, included a possible prolonged clot formation and an impaired or decreased fibrinolysis in patients with BUC. Furthermore, several female specific health issues in thrombosis and haemostasis are investigated in this thesis. In several cohort studies the majority of patients with BUC is female (80%). Bleeding issues in women include, among others, heavy menstrual bleeding and postpartum haemorrhage. It is also known that coagulation factor levels differ between men and women, and some coagulation factors show a cyclic variation. The influence of these differences on haemostasis are still largely unknown, but could play a role in both bleeding and thrombotic complications in women. In this thesis, the presence of an underlying bleeding disorder in women with postpartum haemorrhage, the use of women-specific reference ranges in thrombophilia and the quality of anticoagulation control in women with a mechanical heart valve using vitamin K antagonists were investigated.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall or in the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.