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HERDOO2 rule for discontinuing anticoagulation in unprovoked VTE

Identifies women with unprovoked VTE who may safely stop anticoagulation.

HERDOO2 rule for discontinuing anticoagulation in unprovoked VTE
Post-thrombotic signs: hyperpigmentation, oedema, or redness in either leg
D-dimer >=250 ug/L (while on anticoagulation)
BMI >=30 kg/m2
Age >=65 years
Result0 points

Low risk: recurrence risk is low enough that stopping anticoagulation after short-term therapy is reasonable.

Recommendation
May discontinue

When to use

  • Deciding whether a woman with a first unprovoked VTE can stop anticoagulation after completing initial treatment.

Formula

One point each: leg signs (Hyperpigmentation/Edema/Redness), D-dimer >=250 ug/L, Obesity (BMI>=30), Older (age>=65). Score 0-1 = low risk; >=2 = high risk.

Pearls and pitfalls

  • Derived and validated only in women; men have a higher recurrence rate and are treated as high risk.
  • Does not apply after a provoked VTE or with an ongoing major risk factor.

References

  1. Rodger MA, et al. BMJ. 2017;356:j1065.