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

• Published in: Journal of thrombosis and haemostasis Vol. 10; no. 6; pp. 1019 - 1025
• Main Authors: TOSETTO, A., IORIO, A., MARCUCCI, M., BAGLIN, T., CUSHMAN, M., EICHINGER, S., PALARETI, G., POLI, D., TAIT, R. C., DOUKETIS, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-06-2012
• Subjects: Adolescent; Adult; Age Factors; Aged; Anticoagulants - administration & dosage; Biomarkers - blood; Contraceptives, Oral, Hormonal - adverse effects; Decision Support Techniques; Drug Administration Schedule; D‐dimer; Female; Fibrin Fibrinogen Degradation Products - analysis; Hormone Replacement Therapy - adverse effects; Humans; Male; Middle Aged; Patient Selection; Predictive Value of Tests; Proportional Hazards Models; Recurrence; Retrospective Studies; risk; Risk Assessment; Risk Factors; Sex Factors; Time Factors; Treatment Outcome; Venous Thromboembolism - blood; Venous Thromboembolism - diagnosis; Venous Thromboembolism - drug therapy; venous thrombosis; Vitamin K - antagonists & inhibitors; Young Adult
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/j.1538-7836.2012.04735.x

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.