A clinical decision rule can help clinicians choose which female patients can safely discontinue anticoagulants by identifying those at low-risk of VTE recurrence. The REVERSE II trial, presented yesterday, showed that the HERDOO2 rule can be applied to women after a first unprovoked VTE, making it the only validated rule to do this, according to study investigator Marc Rodger.
HERDOO2 owes its name to the four risk factors which must be considered in determining a patient’s VTE risk recurrence:
VTE is the third most common CV disease after ACS. Short-term treatment with blood thinners can save lives but there’s controversy about continuation of treatment. Most clots are unprovoked and guidelines recommend lifelong blood thinners. However, long-term follow up studies have shown that less than half of patients get recurrent clots if left untreated. The result is that patients continue on blood thinners needlessly.
The REVERSE II trial tested the HERDOO2 rule in a multinational study. A total of 2779 patients (mean age 54.4 years) with a first unprovoked VTE were enrolled after completing at least five and up to 12 months of anticoagulant therapy.
The number considered low-risk based on HERDOO2 criteria was 622, and the majority discontinued anticoagulant therapy. Most of the 591 high-risk women continued anticoagulants.
The primary outcome was recurrent blood clots in low risk women who discontinued blood thinners. The study showed there was a 3% rate of recurrent VTE per patient year for the low-risk women who had discontinued anticoagulants. The rate was 8.1% in high-risk patients who discontinued, and for high-risk patients who continued it was 1.6%.
‘This is an important finding as, using our rule, over half of women with unprovoked VTE can safely discontinue anticoagulants and be spared the burdens, costs, and risks of lifelong anticoagulation,’ said Rodger, from the Ottawa Hospital and University of Ottawa, Ontario, Canada.
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