Background: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. Objectives: We aimed to develop a score that could predict the recurrence risk following a first episode of unprovoked VTE, pooling individual patient data from seven prospective studies. Methods: One thousand eight hundred and eighteen cases with unprovoked VTE treated for at least 3months with a vitamin K antagonist were available for analysis. Optimism-corrected Cox regression coefficients were used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. Results: Abnormal D-dimer after stopping anticoagulation, age <50years, male sex and VTE not associated with hormonal therapy (in women) were the main predictors of recurrence and were used to derive a prognostic recurrence score (DASH, D-dimer, Age, Sex, Hormonal therapy) showing a satisfactory predictive capability (ROC area=0.71). The annualized recurrence risk was 3.1% (95% confidence interval [CI], 2.3-3.9) for a score≤1, 6.4% (95% CI, 4.8-7.9) for a score=2 and 12.3% (95% CI, 9.9-14.7) for a score≥3. By considering at low recurrence risk those patients with a score≤1, life-long anticoagulation might be avoided in about half of patients with unprovoked VTE. Conclusions: The DASH prediction rule appears to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3 months.
|Titolo:||Predicting disease recurrence in patients with previous unprovoked venous thromboembolism : a proposed prediction score (DASH)|
|Parole Chiave:||Decision Support Techniques ; Adolescent ; Adult ; Age Factors ; Aged ; Anticoagulants ; Biological Markers ; Contraceptives, Oral, Hormonal ; Drug Administration Schedule ; Female ; Fibrin Fibrinogen Degradation Products ; Hormone Replacement Therapy ; Humans ; Male ; Middle Aged ; Patient Selection ; Predictive Value of Tests ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sex Factors ; Time Factors ; Treatment Outcome ; Venous Thromboembolism ; Vitamin K ; Young Adult|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
|Data di pubblicazione:||giu-2012|
|Digital Object Identifier (DOI):||10.1111/j.1538-7836.2012.04735.x|
|Appare nelle tipologie:||01 - Articolo su periodico|