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External validation of the DASH prediction rule: a retrospective cohort study
- Publication Year :
- 2017
-
Abstract
- 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. Summary: 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.
- Subjects :
- Male
Pediatrics
Time Factors
Administration, Oral
030204 cardiovascular system & hematology
D-dimer
prediction models
recurrence
risk
venous thromboembolism
Hematology
0302 clinical medicine
Recurrence
Risk Factors
030212 general & internal medicine
Venous Thrombosis
Incidence
Incidence (epidemiology)
Age Factors
Venous Thromboembolism
Middle Aged
Pulmonary embolism
prediction model
Venous thrombosis
Treatment Outcome
Italy
Adult
Aged
Anticoagulants
Biomarkers
Decision Support Techniques
Female
Fibrin Fibrinogen Degradation Products
Humans
Predictive Value of Tests
Pulmonary Embolism
Reproducibility of Results
Retrospective Studies
Risk Assessment
Predictive value of tests
Administration
Cohort
Risk assessment
Oral
medicine.medical_specialty
03 medical and health sciences
Dash
medicine
business.industry
Retrospective cohort study
medicine.disease
Settore MED/15 - MALATTIE DEL SANGUE
D-dimer , deep vein thrombosis
business
human activities
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....f77540d2d84e575872ab694be3fe4f63