title: A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES).
abstract: BACKGROUND
  In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk.
  
  
  METHODS
  In a prospective cohort study, 398 patients with a first unprovoked VTE were followed up for a median of 21.3months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect. Preselected clinical and laboratory variables were analyzed based on the independent confirmation of the impact on the recurrence risk, simplicity of assessment, and reproducibility. Multivariable Cox regression analysis was used to develop a recurrence score that was subsequently internally validated by bootstrap analysis.
  
  
  RESULTS
  A total of 65 patients (16.3%) had recurrent VTE. In all patients, VTE recurred spontaneously. Male sex (HR=2.89 [95% CI 1.21-6.90] P=0.016), age (HR=1.0310 per additional decade [95% CI 1.01-1.07] P=0.011), obesity (HR=3.92 [95% CI 1.75-8.75] P=0.0001), varicose veins (HR=4.14 [95% CI 1.81-9.43] P=0.0001), abnormal D-dimer during anticoagulation (HR=13.66 [95% CI 4.74-39.37] P=0.0001), high factor VIII coagulant activity (HR=1.01 [95% CI 1.00-1.02] P=0.028) and heterozygous of factor V Leiden and/or Prothrombin G20210A mutation (HR=13.86 [95% CI 5.87-32.75] P=0.0001) were related to a higher recurrence risk. Using these variables, we developed a nomogram [hereafter referred to as DAMOVES score (D-dimer, Age, Mutation, Obesity, Varicose veins, Eight, Sex)] for prediction of recurrence in an individual patient.
  
  
  CONCLUSIONS
  The DAMOVES score can be used 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 3months.
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain. Electronic address: aifranco@torrejonsalud.com.
authors.forename: A I
authors.initials: AI
authors.lastname: Franco Moreno
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: García Navarro
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ortiz Sánchez
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain.
authors.forename: R M
authors.initials: RM
authors.lastname: Martín Díaz
authors.affiliation: Internal Medicine Department, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Madroñal Cerezo
authors.affiliation: Internal Medicine Department, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain.
authors.forename: C L
authors.initials: CL
authors.lastname: de Ancos Aracil
authors.affiliation: Internal Medicine Department, Clínico San Carlos University Hospital, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Cabello Clotet
authors.affiliation: Internal Medicine Department, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Perales Fraile
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gimeno García
authors.affiliation: Internal Medicine Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Montero Hernández
authors.affiliation: Internal Medicine Department, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Zapatero Gaviria
authors.affiliation: Internal Medicine Department, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Ruiz Giardín
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Recurrence; Risk; Risk assessment model; Venous thrombosis