title: Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH).
abstract: BACKGROUND
  In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Hematology, S. Bortolo Hospital, Vicenza, Italy. tosetto@hemato.ven.it
authors.forename: A
authors.initials: A
authors.lastname: Tosetto
authors.forename: A
authors.initials: A
authors.lastname: Iorio
authors.forename: M
authors.initials: M
authors.lastname: Marcucci
authors.forename: T
authors.initials: T
authors.lastname: Baglin
authors.forename: M
authors.initials: M
authors.lastname: Cushman
authors.forename: S
authors.initials: S
authors.lastname: Eichinger
authors.forename: G
authors.initials: G
authors.lastname: Palareti
authors.forename: D
authors.initials: D
authors.lastname: Poli
authors.forename: R C
authors.initials: RC
authors.lastname: Tait
authors.forename: J
authors.initials: J
authors.lastname: Douketis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D003278:Contraceptives, Oral, Hormonal; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014812:Vitamin K