Prolonged DAPT After PCI: Risk Score Helps Identify Those Most Likely to Be Harmed

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The DAPT (dual antiplatelet therapy) score helps identify patients for whom prolonged treatment after percutaneous coronary intervention would be harmful, suggests an analysis in the Annals of Internal Medicine.

Researchers retrospectively applied the DAPT score to nearly 2000 patients who had been randomized to either prolonged (24 months) or short-term (≤6 months) DAPT after PCI. The score factors in patient characteristics like age and prior MI (see DAPT score calculator at link below). Some 55% of patients had a DAPT score below 2, suggesting that the bleeding risks of prolonged DAPT would outweigh ischemic benefits; 45% had higher scores, indicating that ischemic benefits would outweigh the risks.

The researchers found that patients with high scores did better with prolonged DAPT in terms of the primary composite outcome of death, MI, or cerebrovascular accident at 6–24 months. Patients with low scores, meanwhile, saw no ischemic benefit from prolonged therapy, but did have increased bleeding risks.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, commented: "Rather than dictate practice, this tool can be helpful in informing decisions by patients, as they may not weigh bleeds and ischemic events equally."