Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH)

Abstract

Summary. Background:In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. Objectives: We aimed to develop a score that could predict the recurrence risk following a first episode of unprovoked VTE, pooling individual patient data from seven prospective studies. Methods: One thousand eight hundred and eighteen cases with unprovoked VTE treated for at least 3 months with a vitamin K antagonist were available for analysis. Optimism-corrected Cox regression coefficients were used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. Results: Abnormal D-dimer after stopping anticoagulation, age < 50 years, male sex and VTE not associated with hormonal therapy (in women) were the main predictors of recurrence and were used to derive a prognostic recurrence score (DASH, D-dimer, Age, Sex, Hormonal therapy) showing a satisfactory predictive capability (ROC area = 0.71). The annualized recurrence risk was 3.1% (95% confidence interval [CI], 2.3-3.9) for a score £ 1, 6.4% (95% CI, 4.8-7.9) for a score = 2 and 12.3% (95% CI, 9.9-14.7) for a score ‡ 3. By considering at low recurrence risk those patients with a score £ 1, life-long anticoagulation might be avoided in about half of patients with unprovoked VTE. Conclusions: The DASH prediction rule appears to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3 months.

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

“…Data from a meta-analysis of individual patient data derived from 1,818 cases enrolled in seven prospective studies that included patients with a first unprovoked VTE who received conventional anticoagulant therapy and were followed for up to 5 years after treatment was stopped was used to develop another clinical prediction rule. 81 The main predictors of recurrence in this database were abnormal D-dimer after stopping anticoagulants, age less than 50 years, male sex and VTE not associated with hormonal therapy (in women) (DASH, D-dimer, age, sex, hormonal therapy). The annualized risk of recurrence was 3.1% (95% CI, 2.3 to 3.9%) for a score of 1 or less.…”

The optimal duration of anticoagulant therapy after unprovoked venous thromboembolism – still a challenging issue

“…In recent years, three scoring models for the assessment of the individual risk of recurrence have been proposed: Herdoo2, Vienna Prediction Model, and Dash [32,33,34]. All scores include male sex and elevated D-Dimer.…”

Mój pacjent leczony sulodeksydem — kiedy i dlaczego stosuję?

“…Zaproponowano stratyfikację ryzyka nawrotu choroby na podstawie skali DASH (D-dimer, age, sex, hormonal therapy), według której ryzyko u chorego należy obliczyć następująco: -nieprawidłowe stężenie D-dimeru po zakończeniu antykoagulacji + 2 punkty; -wiek poniżej 50 lat + 1 punkt; -płeć męska + 1 punkt; -stosowanie doustnej antykoncepcji przy zachorowaniu + 2 punkty [13]. U chorych z wynikiem w skali DASH wynoszącym 1 punkt roczny odsetek nawrotów wynosił 3,1%, u chorych z 2 punktami w tej skali -6,4%, a u pacjentów, którzy uzyskali co najmniej 3 punkty, roczny odsetek nawrotów VTE wynosił 12,3% [13].…”