Utility of the <scp>DASH</scp> score after unprovoked venous thromboembolism; a single centre study

MacDonald, Stephen; Chengal, Rajani; Hanxhiu, Anida; Symington, Emily; Sheares, Karen; Besser, Martin; Thomas, Will

doi:10.1111/bjh.15597

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…The VTE recurrence rate reported here is comparable to two large historical trials using standard intensity warfarin, where recurrence rates of 0Á7/100 patient years and 2Á6/100 patient years, respectively, were reported (Kearon et al, 2003;Ridker et al, 2003). In our previous experience of stopping anticoagulation, for patients with low DASH [abnormal D-dimer, Age ≤ 50 years; male Sex, Hormone use at VTE onset (females only)] scores (≤1), the VTE recurrence rate was 6Á1/100 patient-years (95% CI 3Á9-9Á1) and if the recurrence rate of 0Á7/100 patient-years from this study is compared, there would be a crude estimated 89% reduction in recurrence rate in these patients (MacDonald et al, 2018). The results of that publication came to light during the time period of this audit and lead to a change in treatment strategy in our service.…”

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confidence: 84%

Real world experience at a single centre using low dose direct oral anticoagulants after unprovoked venous thromboembolism

et al. 2019

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confidence: 84%

Real world experience at a single centre using low dose direct oral anticoagulants after unprovoked venous thromboembolism

et al. 2019

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“…It is clear that although each of the discussed clinical prediction models show promise and merit, and in most cases can identify a low-risk population, they each have significant deficiencies, limiting applicability in clinical practice and consequently have not led to recommendations in guidelines [22]. Some of these limiting factors include differing definitions of unprovoked VTE as well as the use of D-dimers as biomarkers, which is confounded by increasing age, and contributes to the poor performance of these risk models in older populations [38,43,45,46]. However, defining a low VTE-recurrence risk group in elderly patients is clinically important, because they concurrently have a high risk of bleeding and clotting.…”

Section: Risk Factors and Clinical Risk Prediction Modelsmentioning

confidence: 99%

Individualised Risk Assessments for Recurrent Venous Thromboembolism: New Frontiers in the Era of Direct Oral Anticoagulants

Wang

Lim

2021

Hemato

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Venous thromboembolism (VTE) is a leading cause of morbidity and mortality and is associated with high recurrence rates. The introduction of direct oral anticoagulants (DOACs) in the 2010s has changed the landscape of VTE management. DOACs have become the preferred anticoagulant therapy for their ease of use, predictable pharmacokinetics, and improved safety profile. Increasingly, guidelines have recommended long term anticoagulation for some indications such as following first unprovoked major VTE, although an objective individualised risk assessment for VTE recurrence remains elusive. The balance of preventing VTE recurrence needs to be weighed against the not insignificant bleeding risk, which is cumulative with prolonged use. Hence, there is a need for an individualised, targeted approach for assessing the risk of VTE recurrence, especially in those patients in whom the balance between benefit and risk of long-term anticoagulation is not clear. Clinical factors alone do not provide the level of discrimination required on an individual level. Laboratory data from global coagulation assays and biomarkers may provide enhanced risk assessment ability and are an active area of research. A review of the prediction models and biomarkers for assessing VTE recurrence risk is provided, with an emphasis on contemporary developments in the era of DOACs and global coagulation assays.

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“…Additionally, there is a significant proportion of patients who are misclassified as having a low risk of recurrent VTE, and thus improved sensitivity across all models is required [14,15]. Furthermore, not all trials support the utility of the available prediction models to accurately risk-stratify patients at low and high risk of recurrent VTE, particularly if local laboratory measurement of D-dimer is included [16,17]. However, despite these limitations, the models discussed have identified factors that have consistently proven valuable in improving the prediction of recurrent VTE.…”

Section: Clinical Risk Prediction Modelsmentioning

confidence: 99%

Predicting the Risk of Recurrent Venous Thromboembolism: Current Challenges and Future Opportunities

Stevens

Peter

Tran

et al. 2020

JCM

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Acute venous thromboembolism (VTE) is a commonly diagnosed condition and requires treatment with anticoagulation to reduce the risk of embolisation as well as recurrent venous thrombotic events. In many cases, cessation of anticoagulation is associated with an unacceptably high risk of recurrent VTE, precipitating the use of indefinite anticoagulation. In contrast, however, continuing anticoagulation is associated with increased major bleeding events. As a consequence, it is essential to accurately predict the subgroup of patients who have the highest probability of experiencing recurrent VTE, so that treatment can be appropriately tailored to each individual. To this end, the development of clinical prediction models has aided in calculating the risk of recurrent thrombotic events; however, there are several limitations with regards to routine use for all patients with acute VTE. More recently, focus has shifted towards the utility of novel biomarkers in the understanding of disease pathogenesis as well as their application in predicting recurrent VTE. Below, we review the current strategies used to predict the development of recurrent VTE, with emphasis on the application of several promising novel biomarkers in this field.

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Utility of the DASH score after unprovoked venous thromboembolism; a single centre study

Cited by 7 publications

References 11 publications

Real world experience at a single centre using low dose direct oral anticoagulants after unprovoked venous thromboembolism

Real world experience at a single centre using low dose direct oral anticoagulants after unprovoked venous thromboembolism

Individualised Risk Assessments for Recurrent Venous Thromboembolism: New Frontiers in the Era of Direct Oral Anticoagulants

Predicting the Risk of Recurrent Venous Thromboembolism: Current Challenges and Future Opportunities

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