DASH Score For Prediction Of Recurrent VTE

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):

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.

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.