Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH)

J Thromb Haemost. 2012 Jun;10(6):1019-25. doi: 10.1111/j.1538-7836.2012.04735.x.


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.

Publication types

  • Meta-Analysis

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Anticoagulants / administration & dosage*
  • Biomarkers / blood
  • Contraceptives, Oral, Hormonal / adverse effects
  • Decision Support Techniques*
  • Drug Administration Schedule
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Hormone Replacement Therapy / adverse effects
  • 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 / blood
  • Venous Thromboembolism / diagnosis*
  • Venous Thromboembolism / drug therapy*
  • Vitamin K / antagonists & inhibitors
  • Young Adult


  • Anticoagulants
  • Biomarkers
  • Contraceptives, Oral, Hormonal
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Vitamin K