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A Practical Guide to Haemostasis


Men and HER-DOO-2 Rule

Introduction:

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 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.

The original study excluded patients with a high-risk thrombophilia profile:
  - Protein C deficiency
  - Protein S deficiency
  - Antithrombin deficiency
  - Persistently positive Anticardiolipin antibodies [> 30 U/mL]
  - Persistently positive Lupus anticoagulant
  - Two or more thrombophilic defects [e.g., homozygosity for the Factor V Leiden or Prothrombin gene mutation, or compound heterozygosity for the Factor V Leiden and Prothrombin gene mutation.

The Men and HER-DOO-2 rule



Select Criteria:

[H] Hyperpigmentation
[E] Edema [Oedema]
[R] Redness of either leg
1 Point if any of these criteria present
[D] D-dimer ≥250 µg/L whilst on Warfarin
1 Point
[O] Obesity BMI ≥30kg/m2
1 Point
[O] Old age [≥65 years]
1 Point



Score


Max Score 4 points

Interpretation
Score Risk Group Annual Risk of Recurrent VTE Recommendations
0 - 1 Low 1.6% Discontinue anticoagulation
2 - 4 High 14.1% Continue oral anticoagulation


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