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HERDOO2 Rule for Anticoagulation Discontinuation After Unprovoked Venous Thromboembolism
Aka: HERDOO2 Rule for Anticoagulation Discontinuation After Unprovoked Venous Thromboembolism, HERDOO2 Model
- See Also
- Anticoagulation in Thromboembolism
- Venous Thromboembolism
- Thrombophilia
- Indications
- Assess a woman's risk of recurrent Venous Thromboembolism (VTE) after stopping Anticoagulation
- Assumes first unprovoked VTE in a woman over age 18 years old
- Contraindications
- Male gender
- HERDOO2 was only developed to assess risk in women
- Male gender alone is a risk for recurrent VTE (RR 1.8 in unprovoked VTE)
- Douketis (2011) BMJ 342: d813 [PubMed]
- Identified Thromboembolism risk
- Leg Fracture or lower extremity plaster cast
- Immobilization >3 days
- General Anesthesia within last 3 months
- Cancer diagnosis within the last 5 years
- Criteria (Score 1 point for each positive)
- Positive D-Dimer
- D-Dimer >250 ng/ml D-Dimer Units (DDU) or
- D-Dimer >0.5 mcg/ml Fibrinogen Equivalent Units or (FEU)
- Body Mass Index (BMI) >=30 kg/m2
- Age >= 65 years old
- Post-Thrombotic Signs (e.g. edema, erythema, Hyperpigmentation)
- Interpretation
- Score 0 to 1: Low Risk (3% recurrent major VTE Risk in 100 person years)
- May discontinue Anticoagulation after initial unprovoked VTE management
- Score 2 to 4: Higher Risk (7.4% recurrent major VTE Risk in 100 person years)
- Continue longterm Anticoagulation after initial unprovoked VTE management
- Resources
- HERDOO2 Rule for Discontinuing Anticoagulation in Unprovoked VTE (MDCalc)
- https://www.mdcalc.com/herdoo2-rule-discontinuing-anticoagulation-unprovoked-vte
- References
- Rodger (2017) BMJ 356 :j1065 +PMID:28314711 [PubMed]