Practical-Haemostasis.com



A Practical Guide to Haemostasis


Venous Thromboembolic Disease [VTED]:
Discontinuing Anticoagulants & The Risk of Recurrence

Introduction

A number of algorithms have been developed to predict the risk of recurrent VTED in patients who have completed a 3-6 month course of anticoagulation following an unprovoked venous thromboembolic event.

These are summarised below with links to the relevant algorithms:

The Men and HER-DOO-2 algorithm


The Men and HER-DOO-2 rule is a clinical prediction rule for estimating the risk of recurrent VTE in women ≥18 years old with a history of an unprovoked VTE. In the original publication, no predictors for a low risk of recurrence were found in men, but in women, a low-risk group was identified - see below.  Women with an unprovoked VTE and a HER-DOO-2 score of 0 - 1 could discontinue anticoagulation whilst women with a score of at least 2 and all men [assuming they tolerate anticoagulation and their risk of bleeding is small] , should continue.

Click HERE to access the Men and HER-DOO-2 algorithm.

The DASH Score


The DASH score is used to calculate the risk of recurrent VTE in an individual with a recent VTE event and who has completed a 3-6 month course of anticoagulation.  The DASH score was developed based upon individuals who had received treatment with a VKA rather than a DOAC.

Click HERE to access the DASH Score.

The Vienna Score


The Vienna Prediction Model is designed to estimate the risk of a recurrent VTE event after an unprovoked venous thromboembolism. It was developed to identify individuals at low risk for VTE recurrence in whom anticoagulation could be stopped after 3 months.

The Revised Vienna Prediction model has replaced the original model. 

Click HERE to access the Vienna Prediction models.