DAPT score: Difference between revisions
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==Overview== | ==Overview== | ||
The DAPT score is a clinical prediction score assessing | The DAPT score is a clinical prediction score assessing ischemic and bleeding risks at 12 to 30 months following [[percutaneous coronary intervention| percutaneous coronary intervention (PCI)]] to inform the duration of [[dual antiplatelet therapy|dual antiplatelet therapy (DAPT)]]. The score was derived from the DAPT study (ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT00977938 NCT00977938]) and initially validated in the PROTECT trial (ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT00476957 NCT00476957]). | ||
==DAPT Score== | ==DAPT Score== | ||
The DAPT score is a simplified clinical prediction score designed to assess the tradeoff between ischemia | 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).<ref name="YehSecemsky2016">{{cite journal|last1=Yeh|first1=Robert W.|last2=Secemsky|first2=Eric A.|last3=Kereiakes|first3=Dean J.|last4=Normand|first4=Sharon-Lise T.|last5=Gershlick|first5=Anthony H.|last6=Cohen|first6=David J.|last7=Spertus|first7=John A.|last8=Steg|first8=Philippe Gabriel|last9=Cutlip|first9=Donald E.|last10=Rinaldi|first10=Michael J.|last11=Camenzind|first11=Edoardo|last12=Wijns|first12=William|last13=Apruzzese|first13=Patricia K.|last14=Song|first14=Yang|last15=Massaro|first15=Joseph M.|last16=Mauri|first16=Laura|title=Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention|journal=JAMA|volume=315|issue=16|year=2016|pages=1735|issn=0098-7484|doi=10.1001/jama.2016.3775}}</ref> The DAPT score has been externally validated in several subsequent studies.<ref name="PiccoloGargiulo2017">{{cite journal|last1=Piccolo|first1=Raffaele|last2=Gargiulo|first2=Giuseppe|last3=Franzone|first3=Anna|last4=Santucci|first4=Andrea|last5=Ariotti|first5=Sara|last6=Baldo|first6=Andrea|last7=Tumscitz|first7=Carlo|last8=Moschovitis|first8=Aris|last9=Windecker|first9=Stephan|last10=Valgimigli|first10=Marco|title=Use of the Dual-Antiplatelet Therapy Score to Guide Treatment Duration After Percutaneous Coronary Intervention|journal=Annals of Internal Medicine|volume=167|issue=1|year=2017|pages=17|issn=0003-4819|doi=10.7326/M16-2389}}</ref><ref name="KereiakesYeh2016">{{cite journal|last1=Kereiakes|first1=Dean J.|last2=Yeh|first2=Robert W.|last3=Massaro|first3=Joseph M.|last4=Cutlip|first4=Donald E.|last5=Steg|first5=P. Gabriel|last6=Wiviott|first6=Stephen D.|last7=Mauri|first7=Laura|title=DAPT Score Utility for Risk Prediction in Patients With or Without Previous Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=67|issue=21|year=2016|pages=2492–2502|issn=07351097|doi=10.1016/j.jacc.2016.03.485}}</ref><ref name="YoshikawaShiomi2018">{{cite journal|last1=Yoshikawa|first1=Yusuke|last2=Shiomi|first2=Hiroki|last3=Watanabe|first3=Hirotoshi|last4=Natsuaki|first4=Masahiro|last5=Kondo|first5=Hirokazu|last6=Tamura|first6=Toshihiro|last7=Nakagawa|first7=Yoshihisa|last8=Morimoto|first8=Takeshi|last9=Kimura|first9=Takeshi|title=Validating Utility of Dual Antiplatelet Therapy Score in a Large Pooled Cohort From 3 Japanese Percutaneous Coronary Intervention Studies|journal=Circulation|volume=137|issue=6|year=2018|pages=551–562|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.028924}}</ref><ref name="BanerjeeAngiolillo2017">{{cite journal|last1=Banerjee|first1=Subhash|last2=Angiolillo|first2=Dominick J.|last3=Boden|first3=William E.|last4=Murphy|first4=Joseph G.|last5=Khalili|first5=Houman|last6=Hasan|first6=Ahmed A.|last7=Harrington|first7=Robert A.|last8=Rao|first8=Sunil V.|title=Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery|journal=Journal of the American College of Cardiology|volume=69|issue=14|year=2017|pages=1861–1870|issn=07351097|doi=10.1016/j.jacc.2017.02.012}}</ref><ref>{{cite journal|title=An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction|journal=New England Journal of Medicine|volume=329|issue=10|year=1993|pages=673–682|issn=0028-4793|doi=10.1056/NEJM199309023291001}}</ref> | ||
==DAPT Score Calculator== | ==DAPT Score Calculator== | ||
Shown below is the calculator for DAPT score (check all the boxes that apply): | Shown below is the calculator for the DAPT score (check all the boxes that apply): | ||
{{#Widget:DAPTscore}} | {{#Widget:DAPTscore}} | ||
==Interpretation== | ==Interpretation== | ||
* Score <2: | * '''Score ≥2 (high score):''' benefit-risk favoring <u>prolonged DAPT</u> 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 <u>aspirin alone</u> 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== | ==See also== | ||
| Line 24: | Line 28: | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Calculator]] | [[Category:Calculator]] | ||
[[Category:Validated score]] | [[Category:Validated score]] | ||
Latest revision as of 21:13, 29 July 2020
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):
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "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.