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DASH Prediction Score for Recurrent VTE

Predicts likelihood of recurrence of first VTE.

Do NOT use in patients with active hemorrhage or signs/symptoms of VTE.

Advice

The DASH score has yet to be externally validated and will require further analysis before it can be used routinely. However, in a patient who is low risk for recurrent VTE and high risk for complications of anticoagulation, the DASH score has the potential to aid and support the decision to discontinue anticoagulation.

Management

In a patient with previously diagnosed VTE who has completed a 3-6 month course of anticoagulation:

  • DASH ≤1:
    • Consider discontinuing anticoagulation as this group has an annual recurrence risk of 3.1%.
  • DASH ≥2:
    • Consider continuing anticoagulation as this group has an annual recurrence risk of 9.3%.

Critical Actions

  • No decision rule should trump clinical gestalt. Consider the clinical scenario before continuing or discontinuing anticoagulation for VTE.
  • The DASH score 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.
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