DASH Prediction Score for Recurrent VTE
Predicts likelihood of recurrence of first VTE.
Do NOT use in patients with:
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Active hemorrhage.
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Signs/symptoms of VTE.
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Active cancer.
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Pregnancy or puerperium.
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Antiphospholipid syndrome.
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Antithrombin deficiency.
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Recurrent VTE.
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Distal DVT as the index event.
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Surgery, trauma, or immobility-associated VTE (these are "provoked" events).
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A score ≤1 does not mean it is safe to stop anticoagulation.
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The decision to stop anticoagulation should consider the entire clinical scenario and a discussion of risk-benefit with the patient.
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Some real world applications of this tool have identified populations, particularly over 65 years old, where the VTE recurrence rate was higher than 5% annually.
In a patient with previously diagnosed VTE who has completed a 3-6 month course of anticoagulation:
- Score ≤1: Consider discontinuing anticoagulation, as this group has an annual recurrence risk of 3.1%.
- Score ≥2: Consider continuing anticoagulation, as this group has an annual recurrence risk of 9.3% (6.4%-12.3%).
- No decision rule should trump clinical gestalt; consider the clinical scenario before continuing or discontinuing anticoagulation for VTE.
- This tool is meant to be applied to stable patients; it should not be applied to patients with active hemorrhage or those with signs and symptoms of VTE.
- Plan the D-dimer draw in advance and counsel patients on VTE symptoms during the window of stopping anticoagulation.
- If stopping anticoagulation, counsel the patient on signs and symptoms of recurrent VTE.