DAPT score

Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Synonyms and Keywords: Dual Antiplatelet Therapy score; DAPT (Dual Antiplatelet Therapy) score; DAPT score calculator; Dual Antiplatelet Therapy score calculator; DAPT (Dual Antiplatelet Therapy) score calculator

Overview

The DAPT score is a clinical prediction score assessing ischemic and bleeding risks at 12 to 30 months following percutaneous coronary intervention (PCI) to inform the duration of dual antiplatelet therapy (DAPT). The score was derived from the DAPT study (ClinicalTrials.gov: NCT00977938) and initially validated in the PROTECT trial (ClinicalTrials.gov: NCT00476957).

DAPT Score

The DAPT score is a simplified clinical prediction score designed to assess the benefit-risk tradeoff between ischemia reduction (myocardial infarction or stent thrombosis) and bleeding increase (moderate or severe hemorrhage) associated with continued thienopyridine plus aspirin versus aspirin alone at 12 to 30 months after PCI based on 11,648 patients enrolled in the DAPT study (derivation cohort) and 8,136 patients enrolled in the PROTECT trial (validation cohort).[1] The DAPT score has been externally validated in several subsequent studies.[2][3][4][5][6]

DAPT Score Calculator

Shown below is the calculator for the DAPT score (check all the boxes that apply):

DAPT Score Calculator
Variable Score
Age ≥ 75 years old -2
65-74 years old -1
< 65 years old 0
Cigarette smoking 1
Diabetes mellitus 1
Prior MI or PCI 1
MI at presentation 1
Paclitaxel-eluting stent 1
Stent diameter < 3 mm 1
CHF or LVEF < 30% 2
Vein graft stent 2
DAPT Score:
Interpretation:

Interpretation

  • Score ≥2 (high score): benefit-risk favoring prolonged DAPT over aspirin alone
  • Greater ischemic reduction (2.7% for prolonged DAPT vs 5.7% for aspirin alone; difference, −3.0% [95% CI, −4.1% to −2.0%]; NNT=34)
  • Smaller bleeding increase (1.8% for prolonged DAPT vs 1.4% for aspirin alone; difference, 0.4% [95% CI, −0.3% to 1.0%])
  • Score <2 (low score): benefit-risk favoring aspirin alone over prolonged DAPT
  • Smaller ischemic reduction (1.7% for prolonged DAPT vs 2.3% for aspirin alone; difference, −0.7% [95% CI, −1.4% to 0.1%])
  • Greater bleeding increase (3.0% for prolonged DAPT vs 1.4% for aspirin alone; difference, 1.5% [95% CI, 0.8% to 2.3%]; NNH=64)

See also

References

  1. Yeh, Robert W.; Secemsky, Eric A.; Kereiakes, Dean J.; Normand, Sharon-Lise T.; Gershlick, Anthony H.; Cohen, David J.; Spertus, John A.; Steg, Philippe Gabriel; Cutlip, Donald E.; Rinaldi, Michael J.; Camenzind, Edoardo; Wijns, William; Apruzzese, Patricia K.; Song, Yang; Massaro, Joseph M.; Mauri, Laura (2016). "Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention". JAMA. 315 (16): 1735. doi:10.1001/jama.2016.3775. ISSN 0098-7484.
  2. Piccolo, Raffaele; Gargiulo, Giuseppe; Franzone, Anna; Santucci, Andrea; Ariotti, Sara; Baldo, Andrea; Tumscitz, Carlo; Moschovitis, Aris; Windecker, Stephan; Valgimigli, Marco (2017). "Use of the Dual-Antiplatelet Therapy Score to Guide Treatment Duration After Percutaneous Coronary Intervention". Annals of Internal Medicine. 167 (1): 17. doi:10.7326/M16-2389. ISSN 0003-4819.
  3. Kereiakes, Dean J.; Yeh, Robert W.; Massaro, Joseph M.; Cutlip, Donald E.; Steg, P. Gabriel; Wiviott, Stephen D.; Mauri, Laura (2016). "DAPT Score Utility for Risk Prediction in Patients With or Without Previous Myocardial Infarction". Journal of the American College of Cardiology. 67 (21): 2492–2502. doi:10.1016/j.jacc.2016.03.485. ISSN 0735-1097.
  4. Yoshikawa, Yusuke; Shiomi, Hiroki; Watanabe, Hirotoshi; Natsuaki, Masahiro; Kondo, Hirokazu; Tamura, Toshihiro; Nakagawa, Yoshihisa; Morimoto, Takeshi; Kimura, Takeshi (2018). "Validating Utility of Dual Antiplatelet Therapy Score in a Large Pooled Cohort From 3 Japanese Percutaneous Coronary Intervention Studies". Circulation. 137 (6): 551–562. doi:10.1161/CIRCULATIONAHA.117.028924. ISSN 0009-7322.
  5. Banerjee, Subhash; Angiolillo, Dominick J.; Boden, William E.; Murphy, Joseph G.; Khalili, Houman; Hasan, Ahmed A.; Harrington, Robert A.; Rao, Sunil V. (2017). "Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery". Journal of the American College of Cardiology. 69 (14): 1861–1870. doi:10.1016/j.jacc.2017.02.012. ISSN 0735-1097.
  6. "An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction". New England Journal of Medicine. 329 (10): 673–682. 1993. doi:10.1056/NEJM199309023291001. ISSN 0028-4793.