For healthcare professionals
DASH score calculator
The DASH score estimates the yearly risk of a new blood clot in a vein (recurrent venous thromboembolism) after a first unprovoked deep vein thrombosis or pulmonary embolism, once anticoagulant treatment has stopped. It uses four items: D-dimer, Age, Sex and Hormone use. This tool is written for clinicians deciding how long to treat. It is not a self-check and not a diagnosis.
Patient findings
For an adult who has finished at least 3 months of anticoagulation for a first unprovoked venous thromboembolism, with a D-dimer taken after stopping. Nothing you enter leaves this page.
What you will see
The DASH score from -2 to 4, the points for each item and the published annual recurrence rate for that score.
Educational only, not medical advice. A score never replaces the judgment of the treating team.
Source
The DASH score by Tosetto and colleagues, Journal of Thrombosis and Haemostasis 2012, with the items, points and annual recurrence rates as printed in the open access review by Palareti, Scientifica 2012 (CC BY), and the age cut-off and score range as printed in Streiff and colleagues, Journal of Thrombosis and Thrombolysis 2016 (CC BY 4.0). The tests check each item, the age edge, the hormone item in women only, the range of -2 to 4 and the rate for every score.
Validated in
A patient-level meta-analysis of 1818 patients with a first unprovoked venous thromboembolism from 7 prospective studies, who had received anticoagulant therapy for at least 3 months and were followed for up to 5 years after it was stopped. We cite the 2012 paper but do not quote it, because its license does not allow reuse here.
Limits
For a first unprovoked VTE after anticoagulation has stopped, not for clots linked to surgery, trauma, active cancer, immobility or pregnancy. Hormone-associated clots in women were counted as unprovoked. The rates are group figures, not a prediction for one patient. Most patients in the studies were treated with vitamin K antagonists, and there is limited evidence for the score with other anticoagulants. In patients over 65, the recurrence risk was above 5% a year even with a low DASH score. An age of 50 counts; Streiff 2016 prints the item as 50 or under, while Palareti 2012 and Weitz 2020 print it as under 50.
The point table
DASH score, as printed in Palareti 2012 and Streiff 2016 (Palareti 2012) (Streiff 2016) (Tosetto 2012):
- Abnormal D-dimer after stopping anticoagulation: 2
- Age 50 years or under: 1
- Male Sex: 1
- Hormone use at the time of the first clot, in women: -2
The total ranges from -2 to 4 (Streiff 2016). Weitz and colleagues describe the D-dimer as measured 3 to 5 weeks after stopping anticoagulation (Weitz 2020). Worked example: a 58-year-old man (1) with an abnormal D-dimer after stopping (2) scores 3. A 34-year-old woman (1) whose clot happened while she was taking hormones (-2), with an abnormal D-dimer (2), scores 1.
Annual recurrence rates
Palareti gives the annualized risk of recurrent VTE by DASH score from the original meta-analysis (Palareti 2012):
- Score 1 or less: 3.1% per year (95% CI 2.3 to 3.9)
- Score 2: 6.4% per year (95% CI 4.8 to 7.9)
- Score 3 or more: 12.3% per year (95% CI 9.9 to 14.7)
Streiff and colleagues note that annual recurrence rates across DASH scores of -2 to 4 ranged from 1.8% to 19.9% (Streiff 2016). Stevens and colleagues summarize the rate as 3.1% for a score of 1 or less and 9.3% for a score above 1 (Stevens 2020). About half of the patients in the original study had a score of 1 or less (Palareti 2012).
Reading the result
On the basis of the low recurrence risk with a score of 1 or less, the authors suggested avoiding life-long anticoagulation in these patients (Palareti 2012). Weitz and colleagues write that patients who score 2 or more should be considered at high risk of recurrence and eligible for extended treatment (Weitz 2020). The score was externally validated in a retrospective cohort (Tosetto 2017), and Stevens and colleagues point out that the clinical prediction models for recurrent VTE still classify a share of patients as low risk who go on to have a recurrence (Stevens 2020). The decision to stop or continue treatment also weighs the risk of bleeding on anticoagulation and the patient's own preferences; the score does not make that decision on its own.
Related tools
When a clot is suspected, see the Wells score for DVT and the Wells score for PE; once a pulmonary embolism is confirmed, the PESI score calculator. For clot risk in outpatients with cancer starting chemotherapy, see the Khorana score. For women, the HERDOO2 rule is scored while still on treatment. For bleeding risk while on a blood thinner for a clot, see the VTE-BLEED score. Other bedside scores are listed under For healthcare professionals.
Sources
- Palareti G. Recurrent venous thromboembolism: what is the risk and how to prevent it. Scientifica (Cairo). 2012;2012:391734. doi:10.6064/2012/391734. PMID 24278687. Open access (CC BY). Section 7: DASH items, points and annualized recurrence risk by score. pmc.ncbi.nlm.nih.gov/articles/PMC3820456/
- Streiff MB, Agnelli G, Connors JM, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis. 2016;41(1):32-67. doi:10.1007/s11239-015-1317-0. PMID 26780738. Open access (CC BY 4.0). pmc.ncbi.nlm.nih.gov/articles/PMC4715858/
- Tosetto A, Iorio A, Marcucci M, et al. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost. 2012;10(6):1019-1025. doi:10.1111/j.1538-7836.2012.04735.x. PMID 22489957. doi.org/10.1111/j.1538-7836.2012.04735.x
- Tosetto A, Testa S, Martinelli I, et al. External validation of the DASH prediction rule: a retrospective cohort study. J Thromb Haemost. 2017;15(10):1963-1970. doi:10.1111/jth.13781. PMID 28762665. doi.org/10.1111/jth.13781
- Weitz JI, Prandoni P, Verhamme P. Anticoagulation for patients with venous thromboembolism: when is extended treatment required? TH Open. 2020;4(4):e446-e456. doi:10.1055/s-0040-1721735. PMID 33376944. Open access (CC BY). Table 4 (HERDOO2 items, women only, low score of 1 or less). pmc.ncbi.nlm.nih.gov/articles/PMC7758152/
- Stevens H, Peter K, Tran H, McFadyen J. Predicting the risk of recurrent venous thromboembolism: current challenges and future opportunities. J Clin Med. 2020;9(5):1582. doi:10.3390/jcm9051582. PMID 32456008. Open access (CC BY). Table 1 (HERDOO2 inclusion, groups and annualised recurrence risk). pmc.ncbi.nlm.nih.gov/articles/PMC7290951/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-03. Spotted an error? See About.