Pulmonary embolism
HERDOO2
Men continue to have a high recurrence risk and are not candidates for this rule. In women with a first unprovoked VTE treated for 5–12 months, a HERDOO2 score of 0–1 identifies those who can safely stop anticoagulation (REVERSE II: 3.0% recurrence per year after stopping). Items: Hyperpigmentation, Edema or Redness of either leg; D-dimer ≥ 250 µg/L on anticoagulation; Obesity (BMI ≥ 30); Older age (≥ 65).
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Criteria
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- For women with a first unprovoked proximal DVT or PE only. Men and women with provoked VTE, cancer, or a strong thrombophilia are outside the rule.
Total score
0
Low risk (women): anticoagulation can be stopped
Recurrence after stopping ≈ 3.0% per patient-year (REVERSE II)
Decision guide
Stop anticoagulation after 5–12 months of treatment. Advise on symptoms and thromboprophylaxis in future high-risk situations (surgery, immobility, pregnancy). Applies to women only.
Ranges: 0–1 Low risk (women): anticoagulation can be stopped2–4 High risk: continue anticoagulation
References
- Rodger MA, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ 2008;179:417-426.
- Rodger MA, et al. Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study (REVERSE II). BMJ 2017;356:j1065.
- Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J 2020;41:543-603.
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