HERDOO2_Rule_for_Discontinuing_Anticoagulation_in_Unprovoked_VTE v.1
Indefinite anticoagulation is burdensome and associated with bleeding risk. The HERDOO2 Rule for Discontinuing Anticoagulation in Unprovoked VTE Identifies low-risk women who can safely discontinue Venous thromboembolism (VTE) treatment. The HERDOO2 Score is calculated by adding the selected points: Post-thrombotic signs* No Yes D-dimer level <250 µg/L ≥250 µg/L BMI, kg/m² <30 ≥30 Age, years <65 ≥65 *Hyperpigmentation, edema, or redness (either leg) It is interpreted as: HERDOO2 Risk group Risk of recurrent major VTE* Recommendation 0-1 Low 3.0% Can safely discontinue oral anticoagulation 2-4 Not low 7.4% Continue oral anticoagulation *Proximal DVT and segmental or greater PE, % per 100 patient years.
Identifies low-risk women who can safely discontinue VTE treatment.
The HERDOO2 Rule can identify patients who have very low risk of recurrent VTE and can therefore safely stop anticoagulation in the short term. Use for women ≥18 years old with unprovoked VTE. Inclusion criteria in the original study was: - Patients diagnosed 5–7 months before enrollment. - On heparin or low molecular weight heparin (LMWH) for ≥5 days and oral anticoagulation for 5–7 months after the event. - Without recurrent VTE during the treatment period. - Noncompressible segment on compression ultrasound of popliteal (or more proximal) leg vein, high-probability V/Q scan, or segmental (or larger) artery filling defect on spiral CT. Exclusion criteria: - Leg fracture. - Lower-extremity plaster cast. - Immobilization for >3 days. - General anesthetic <3 months before index event. - Cancer diagnosis within 5 years.
Do not use in patients with any of the following at the time of VTE diagnosis: leg fracture, lower-extremity plaster cast, immobilization >3 days, general anesthesia <3 months before, or cancer diagnosis within 5 years.
Rodger MA, Kahn SR, Wells PS, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ. 2008;179(5):417-26. Validation Rodger MA, Le gal G, Anderson DR, et al. Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study. BMJ. 2017;356:j1065.
OBSERVATION.herdoo2_rule_for_discontinuing_anticoagulation_in_unprovoked_vte.v0, EVALUATION.herdoo2_rule_for_discontinuing_anticoagulation_in_unprovoked_vte.v0
