Tosetto, A., Iorio, A., Marcucci, M., Baglin, T., Cushman, M., Eichinger, S., Palareti, G., Poli, D., Tait, R.C. and Douketis, J. (2012) Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). Journal of Thrombosis and Haemostasis, 10(6), pp. 1019-1025. (doi: 10.1111/j.1538-7836.2012.04735.x) (PMID:22489957)
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Abstract
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.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Tait, Dr Robert |
| Authors: | Tosetto, A., Iorio, A., Marcucci, M., Baglin, T., Cushman, M., Eichinger, S., Palareti, G., Poli, D., Tait, R.C., and Douketis, J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Journal of Thrombosis and Haemostasis |
| Publisher: | Wiley |
| ISSN: | 1538-7933 |
| ISSN (Online): | 1538-7836 |
| Published Online: | 10 April 2012 |
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