Before adopting a clinical decision rule in clinical practice it should be prospectively validated in multiple clinical settings.17 As such, we validated the HERDOO2 clinical decision rule in a multinational prospective cohort management study.We conducted a prospective multinational cohort management study of patients with a first unprovoked VTE event who were included after 5-12 months of anticoagulant treatment.If you don't know how, you will need to contact your DNS provider.
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In 323 high risk women and men who discontinued anticoagulants, 25 had VTE during 309 patient years of follow-up (8.1%, 5.2% to 11.9%), whereas in 1802 high risk women and men who continued anticoagulants 28 had recurrent VTE during 1758 patient years of follow-up (1.6%, 1.1% to 2.3%).
Conclusions Women with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment. Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common, potentially fatal yet treatable condition.
Results Of 1213 women, 631 (51.3%) were classified as low risk and 591 discontinued oral anticoagulant treatment.
In the primary analysis, 17 low risk women who discontinued anticoagulants developed recurrent VTE during 564 patient years of follow-up (3.0% per patient year, 95% confidence interval 1.8% to 4.8%).
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Patients who do not bleed during this time, termed “anticoagulant experienced” patients, are at lower risk of major bleeding with ongoing treatment (1.3% per year).7 Major bleeding is fatal in 11.3% of affected patients.6Guidelines recommend long term anticoagulant treatment in patients with unprovoked VTE with non-high bleeding risks, but this is based on weak evidence (grade 2B)11 owing to closely balanced competing risks and burdens of recurrent VTE and major bleeding.