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Criteria for validating assessment tools Free sexy chatline trials

Results Of 1213 women, 631 (51.3%) were classified as low risk and 591 discontinued oral anticoagulant treatment.In the primary analysis, 17 low risk women who discontinued anticoagulants developed recurrent VTE during 564 patient years of follow-up (3.0% per patient year, 95% confidence interval 1.8% to 4.8%).High risk thrombophilia included deficiency of protein S, protein C, or antithrombin, persistently positive antiphospholipid antibodies, or two or more known other thrombophilic defects (eg, homozygous for factor V Leiden mutation or prothrombin gene mutation, or compound heterozygous for factor V Leiden and prothrombin gene mutation)); were geographically inaccessible for follow-up; had planned to use exogenous oestrogen (patch, ring, oral contraceptive, or hormone replacement therapy) if anticoagulant treatment was discontinued; or had pregnancy associated index VTE (antepartum or postpartum (within 12 weeks of delivery)).The baseline assessment took place 5-12 months after the index VTE event, while patients were still receiving oral anticoagulant treatment.In 323 high risk women and men who discontinued anticoagulants, 25 had VTE during 309 patient years of follow-up (8.1%, 5.2% to 11.9%), whereas in 1802 high risk women and men who continued anticoagulants 28 had recurrent VTE during 1758 patient years of follow-up (1.6%, 1.1% to 2.3%).Conclusions Women with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment. Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common, potentially fatal yet treatable condition.

Consecutive unselected patients at 44 secondary and tertiary care centres in seven countries (see supplementary appendix) were asked to participate if they had a first episode of major, symptomatic, objectively proved unprovoked VTE 5-12 months before enrolment (referred to as the index VTE).Per protocol, low risk patients were to discontinue anticoagulants (intervention arm), whereas anticoagulant management in high risk patients was left to the discretion of the clinicians and patients (observation arm).Participants were then followed for one year for recurrent VTE and major bleeding.Before adopting a clinical decision rule in clinical practice it should be prospectively validated in multiple clinical settings.17 As such, we validated the HERDOO2 clinical decision rule in a multinational prospective cohort management study.We conducted a prospective multinational cohort management study of patients with a first unprovoked VTE event who were included after 5-12 months of anticoagulant treatment.Women were classified as low risk if they had none or one of the four HERDOO2 criteria (fig 1).Women who met two or more criteria and all men were classified as high risk.We then applied the HERDOO2 clinical decision rule.Per protocol, low risk women were to discontinue oral anticoagulant treatment, whereas continuation of anticoagulation in men and high risk women was left to the discretion of the clinicians and patients.We also obtained baseline results for bilateral leg compression ultrasonography and either a ventilation-perfusion scan or perfusion only scan or CT pulmonary angiography.Baseline imaging was conducted to assist in the diagnosis of subsequent suspected recurrent VTE in patients who discontinued anticoagulants.


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