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Main outcome measure Recurrent symptomatic VTE (independently and blindly adjudicated) over one year of follow-up.Results Of 1213 women, 631 (51.3%) were classified as low risk and 591 discontinued oral anticoagulant treatment.I would not put any constraints on a user name - it may even contain numbers; think of aristocratic names. No matter what regex you come up with, I can find a name somewhere in the world that will break it.That being said, you do need to sanitize input, to avoid the Little Bobby Tables problem.Objective To prospectively validate the HERDOO2 rule (Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years), which states that women with none or one of the criteria can safely discontinue anticoagulants after short term treatment. Setting 44 secondary or tertiary care centres in seven countries.Participants Of 3155 consecutive eligible participants with a first unprovoked venous thromboembolism (VTE, proximal leg deep vein thrombosis or pulmonary embolism) who completed 5-12 months of short term anticoagulant treatment, 370 declined to participate, leaving 2785 enrolled participants. Interventions Women with none or one of the HERDOO2 criteria were classified as at low risk of recurrent VTE and discontinued anticoagulants (intervention arm), whereas anticoagulant management for high risk women (≥2 HERDOO2 criteria) and men was left to the discretion of the clinicians and patients (observation arm).

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Some patient subgroups with major provoking factors (eg, post-surgical VTE) have a low risk of recurrent VTE (1% at one year)1 and anticoagulants can be safely discontinued after short term treatment.2 However, more than 50% of patients with VTE do not have a major provoking factor.3 In these patients with unprovoked VTE, the risk of recurrent VTE is substantially higher; up to 10% in the first year after stopping short term treatment, 5% in the subsequent year,4 and 30% at eight years.5 Recurrent VTE is fatal in 3.6% of cases.6Oral anticoagulant treatment is effective at reducing the risk of recurrent VTE during treatment; oral anticoagulant treatment reduces the risk of recurrent VTE by 80-90%.7 Longer term oral anticoagulant treatment likely only delays recurrent VTE compared with short term treatment.8910 The highest bleeding risks are observed during initial oral treatment.

Patients who do not bleed during this time, termed “anticoagulant experienced” patients, are at lower risk of major bleeding with ongoing treatment (1.3% per year).7 Major bleeding is fatal in 11.3% of affected patients.6Guidelines recommend long term anticoagulant treatment in patients with unprovoked VTE with non-high bleeding risks, but this is based on weak evidence (grade 2B)11 owing to closely balanced competing risks and burdens of recurrent VTE and major bleeding.

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.

After short term oral anticoagulant treatment, the risk of recurrent VTE after discontinuing anticoagulants is variable, depending on the presence or absence of provoking factors at the time of the initial event.




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