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HERDOO2 score identifies pulmonary embolism patients at low risk of recurrence

24 Aug 2020

The Men Continued and HERDOO2 score appears to be a good predictor of a low recurrence risk in patients with a first unprovoked pulmonary embolism after treatment discontinuation, suggests a study. The addition of pulmonary vascular obstruction index (PVOI) improves the accuracy of all venous thromboembolism recurrence scores.

The investigators validated the HERDOO2; D-dimer, age, sex, hormonal therapy (DASH); and updated Vienna recurrent venous thromboembolism prediction models in patients with first unprovoked pulmonary embolism. They also analysed the effect of adding the PVOI on score accuracy.

Analyses were based on the double-blind, randomized PADIS-PE trial, which included 371 unprovoked pulmonary patients who underwent treatment for 6 months, were subsequently randomized to receive an additional 18 months of warfarin or placebo, and were then followed for 2 years.

C-statistics of the HERDOO2, DASH, and updated Vienna scores were 0.61 (95 percent confidence interval [CI], 0.54–0.68), 0.60 (95 percent CI, 0.53–0.66), and 0.58 (95 percent CI, 0.51–0.66), respectively. Of these, only HERDOO2 successfully identified patients with low recurrence risk (<3 percent per year) after cessation of anticoagulation therapy.

When added to either of the prediction models. PVOI measured at pulmonary embolism diagnosis, after 6 months of anticoagulation, or both resulted in improved C-statistics of all scores between 0.06 and 0.11 points. Additionally, it consistently identified at least 50 percent of patients who experienced recurrence but in whom the scores would have indicated against extended anticoagulation.

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 3 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
5 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.