Coagulation

HERDOO criteria shown to predict recurrent VTE risk


Risk stratification is possible for women on anticoagulant therapy following a first unprovoked episode of VTE, according to new research.

The international study found that women with none or only one of the HERDOO criteria can safely be classified as low risk for recurrent VTE and discontinue their anticoagulants after short-term treatment.

According to the International Society of Thrombosis and Haemostasis it is safe to discontinue anticoagulants if the risk is less than 5%.

The HERDOO clinical criteria are hyperpigmentation, edema or redness in either leg; D-Dimer level ≥ 250ug/L during treatment; obesity (BMI ≥30) and older age (≥65 years).

The study of 2785 participants from 44 centres in seven countries classified 51.3% of the women as low risk. Those who then ceased anticoagulants had a 3% risk of a subsequent major VTE during the 12-month follow-up period.

“This is an important finding because using our rule over half of women with unprovoked VTE can safely discontinue anticoagulants and be spared the burdens, costs and risks of indefinite anticoagulation,” the researchers wrote.

“Most low risk patients stopped anticoagulants (95%) as planned, suggesting the rule was acceptable to clinicians and patients.”

A sub-group analysis showed the finding applied to low risk women regardless of whether or not their VTE was associated with exogenous oestrogen use.

The risk of subsequent VTE was however higher in low-risk women of post-menopausal age ≥50 years.

The study found women who were classified as high risk, with two or more of the HERDOO criteria, and discontinued anticoagulants had a similar risk of subsequent VTE as men who discontinued therapy (8.1% v 7.4%).

Participants included those on vitamin K antagonists and direct oral anticoagulants.

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