DASH Score For Prediction Of Recurrent VTE

Indicates risk of venous thromboembolism based on D-dimer test results and other patient characteristics.

You can read more about the DASH score criteria and about the risk percentages awarded to score results, in the text below the calculator.


The DASH score calculator determines the risk of a venous thromboembolism occurring based on the age and gender of the patient, whether the D-dimer test is abnormal and whether the patient is under hormonal therapy.

The original study has concluded that abnormal D-dimer findings after coagulation was stopped, male gender, age below 50 and the cause not associated with hormonal therapy are important risk factors for recurrence.


The risk of VTE recurrence allows clinicians to make informed decisions in regard to anticoagulation treatment length in patient who have suffered an unprovoked venous thromboembolism.

In patients with DASH scores of 1 and below, anticoagulation can be stopped after 3 to 6 months, without any major risks while in patients with DASH scores of 2 and above, medication should be continued.


1

D-dimer Abnormal

2

Age less than or equal to 50 years

3

Sex

4

Hormone use at VTE onset

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DASH score items explained

As a predictor for recurrence of venous thromboembolism, the score is calculated based on the variables presented in the table below (along with the number of points awarded in the score):

DASH item Answer choices
D-dimer abnormal result Yes (2)
No (0)
Age less than or equal to 50 years Yes (1)
No (0)
Gender Male (1)
Female (0)
Hormone use at VTE onset Yes (-2)
No (0)

The name of the score (DASH) is actually the acronym of the 4 variables it accounts for.

DASH allows medical professionals to rapidly stratify patient risk of venous thromboembolism based on data readily available and helps decision making in prescribing or stopping existing anticoagulation medication.

The score’s reliability has been proven in patients that have already suffered an unprovoked VTE.

 

Score interpretation

In patients who are under anticoagulation treatment after an unprovoked venous thromboembolism, the calculation of recurrence risk informs decisions about optimal duration of anticoagulation.

Official guidelines recommend a period of at least 3 months of vitamin K antagonist treatment, before clearance can be offered.

Combined with the following recurrence risk percentages, anticoagulation can be stopped after 3-6 months in patients with DASH scores of 1 or less. In patients with scores above 2, the recommendation is to continue the therapy beyond this time.

VTE annual reccurence rates
DASH Percentage risk
-2 1.80%
-1 1%
0 2.40%
1 3.90%
2 6.30%
3 10.80%
4 19.90%
 

About the study

DASH was created by Tosetto et al. in 2012 following a study on a cohort of 1,818 patients with a history of VTE, no other comorbidities and no antithrombin deficiencies.

Patients that have underwent surgery, trauma or have been immobilized for long periods of time have been excluded, as to avoid provoked VTEs.

The study has explored VTE recurrence during the first year after the unprovoked VTE.

The score is essentially designed to help clinicians to decide whether to continue anticoagulation after the standard recommended period of 3 months.

In general, VTE recurrence risk on a medium term (5 years) is around 27% and seems to decrease in time.

On the other hand, risk of bleeding complications can increase in time due to prolonged anticoagulation, thus the score can help avoid subjecting eligible patients to unnecessary risks.

The main limitation of the model consists in the fact that it has yet to be externally validated and the fact that in high risk cases, it’s accuracy is less reliable upon.

 

Venous thromboembolism

VTE represents a group of conditions that include DVT – deep venous thrombosis and PE – pulmonary embolism.

Although occurrence is common, the condition can lead to serious and long term complications and possibly lethal consequences.  

Some of the VTE risk factors include:

■ Heredity;

■ Hypertension;

■ Diabetes mellitus;

■ Venous damage or stasis;

■ Immobilisation after trauma or surgery;

■ Sedentarism;

■ Antithrombin deficiency;

■ Protein C or S deficiency;

■ Elevated levels of factor VIII.

VTE is the third cardiovascular disease in order of occurrence, after stroke and acute coronary syndrome. Two out of three VTW cases require medical intervention.

Diagnosis is based on sensible D-dimer assay, duplex ultrasonogaphy and contrast venography.

 

Original source

Tosetto A, Iorio A, Marcucci M, Baglin T, Cushman M, Eichinger S, Palareti G, Poli D, Tait RC, Douketis J. (2012) Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost. 2012; 10(6):1019-25.

Other references

1. Baglin T, Palmer CR, Luddington R, Baglin C. Unprovoked recurrent venous thrombosis: prediction by D-dimer and clinical risk factors. J Thromb Haemost. 2008; 6(4):577-82.

2. Agnelli G, Becattini C. Treatment of DVT: how long is enough and how do you predict recurrence. J Thromb Thrombolysis. 2008; 25(1):37-44.


App Version: 1.0.1

Coded By: MDApp

Specialty: Vascular Surgery

Objective: Risk Predictor

No. Of Items: 4

Year Of Study: 2012

Abbreviation: DASH

Article By: Denise Nedea

Published On: March 16, 2017 · 08:28 AM

Last Checked: March 16, 2017

Next Review: March 10, 2018