Hematology Department, San Bortolo Hospital, Vicenza, Italy.
Hemostasis and Thrombosis Center, AO Istituti Ospitalieri di Cremona, Cremona, Italy.
J Thromb Haemost. 2017 Oct;15(10):1963-1970. doi: 10.1111/jth.13781. Epub 2017 Aug 23.
Essentials Predicting recurrences may guide therapy after unprovoked venous thromboembolism (VTE). We evaluated the DASH score in 827 patients with unprovoked VTE to verify prediction accuracy. A DASH score ≤ 1 had a cumulative recurrence risk at 1 year of 3.6%, as predicted by the model. The DASH score performed better in younger (< 65 years old) subjects.
Background The DASH prediction model has been proposed as a guide to identify patients at low risk of recurrence of venous thromboembolism (VTE), but has never been validated in an independent cohort. Aims To validate the calibration and discrimination of the DASH prediction model, and to evaluate the DASH score in a predefined patient subgroup aged > 65 years. Methods Patients with a proximal unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who received a full course of vitamin K antagonist or direct oral anticoagulant (> 3 months) and had D-dimer measured after treatment withdrawal were eligible. The DASH score was computed on the basis of the D-dimer level after therapy withdrawal and personal characteristics at the time of the event. Recurrent VTE events were symptomatic proximal or distal DVT/PE, and were analyzed with a time-dependent analysis. Observed 12-month and 24-month recurrence rates were compared with recurrence rates predicted by the DASH model. Results We analyzed a total of 827 patients, of whom 100 (12.1%) had an objectively documented recurrence. As compared with the original DASH cohort, there was a greater proportion of subjects with a 'low-risk' (≤ 1) DASH score (66.3% versus 51.6%, P < 0.001). The slope of the observed versus expected cumulative incidence at 2 years was 0.71 (95% confidence interval 0.51-1.45). The c-statistic was lower for subjects aged > 65 years (0.54) than for younger subjects (0.72). Conclusions These results confirm the validity of DASH prediction model, particularly in young subjects. The recurrence risk in elderly patients (> 65 years) was, however, > 5% even in those with the lowest DASH scores.
预测复发有助于指导不明原因静脉血栓栓塞症（VTE）后的治疗。我们评估了 827 例不明原因 VTE 患者的 DASH 评分，以验证该模型的预测准确性。模型预测 DASH 评分≤1 的患者在 1 年内的累积复发风险为 3.6%。DASH 评分在较年轻（<65 岁）的患者中表现更好。
DASH 预测模型已被提出作为识别静脉血栓栓塞症（VTE）复发风险低的患者的指南，但尚未在独立队列中得到验证。
验证 DASH 预测模型的校准和区分能力，并评估 DASH 评分在年龄>65 岁的预设患者亚组中的表现。
符合条件的患者为接受全疗程维生素 K 拮抗剂或直接口服抗凝剂（>3 个月）治疗的近端无诱因深静脉血栓形成（DVT）或肺栓塞（PE）患者，且在停药后检测 D-二聚体。DASH 评分基于治疗后 D-二聚体水平和事件发生时的个人特征计算。复发性 VTE 事件为有症状的近端或远端 DVT/PE，并进行时间依赖性分析。观察到的 12 个月和 24 个月的复发率与 DASH 模型预测的复发率进行比较。
我们共分析了 827 例患者，其中 100 例（12.1%）有客观记录的复发。与原始 DASH 队列相比，具有“低风险”（≤1）DASH 评分的患者比例更大（66.3%比 51.6%，P<0.001）。2 年时观察到的与预期累积发生率的斜率为 0.71（95%置信区间 0.51-1.45）。年龄>65 岁的患者（0.54）的 C 统计量低于较年轻的患者（0.72）。
这些结果证实了 DASH 预测模型的有效性，特别是在年轻患者中。然而，在年龄较大的患者（>65 岁）中，即使是 DASH 评分最低的患者，复发风险也>5%。
