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TOSETTO, A.; IORIO, A.; MARCUCCI, M.; BAGLIN, T.; CUSHMAN, M.; EICHINGER, S.; PALARETI, G.; POLI, D.; TAIT, R. C.; DOUKETIS, J.
Journal of thrombosis and haemostasis, June 2012, 2012-Jun, 2012-06-00, Letnik: 10, Številka: 6Journal Article
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 3 months 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 < 50 years, 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.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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