DASH Prediction Score for Recurrent VTE
Do NOT use in patients with active hemorrhage or signs/symptoms of VTE.
In a patient who has been previously diagnosed with VTE and has completed a 3-6 month course of anticoagulation, a DASH score of ≤1 is associated with an annual risk of recurrence of 3.1%, which may be low enough to suggest discontinuing anticoagulation therapy. Conversely, a patient with a DASH score of ≥2 is at high risk for recurrent VTE and may require long-term anticoagulation.
The DASH prediction rule is a risk stratification tool which aids physicians in deciding whether a patient with their first unprovoked venous thromboembolism (VTE) is at risk for recurrence and could aid in deciding how long a patient should be on anticoagulation.
- Patients were excluded from this study if they had antiphospholipid antibodies or antithrombin deficiency, or surgery, trauma, active cancer, immobility, or pregnancy/peripartum status, as these were thought to be “provoked” or “secondary” VTEs.
- There is controversy regarding the length of time a patient should be anticoagulated after their first VTE.
- The d-dimer test is measured ~1 month after stopping anticoagulation.
- The cited 5-year recurrence rate of VTE is 25-30%.
- The risk recurrence of VTE decreases with time.
- The risk of bleeding complications due to anticoagulation increases with time of use.
- The DASH score has yet to be externally validated.
- Anticoagulation in this study was limited to vitamin K antagonists, and its use with other drug classes has yet to be established.
- The DASH score was developed using meta-analysis of previously performed studies. Further prospective studies are required to confirm its utility.
Many patients who are diagnosed with VTE are put on long-term or even life-long anticoagulation. The DASH score predicts those individuals that may be low-risk enough to stop anticoagulation after an appropriate 3-6 month period.