A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making.

Abstract

The originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy1 duration after PCI. It is unknown if a simplified version of the score based on 4 factors (age, hemoglobin, creatinine clearance, prior bleeding), and lacking white-blood cell count, retains potential to guide DAPT duration. The 4-item PRECISE-DAPT was used to categorize 10,081 patients who were randomized to short (3-6 months) or long (12-24 months) DAPT regimen according to high (HBR defined by PRECISE-DAPT ≥25 points) or non-high bleeding risk (PRECISE-DAPT<25) status. Long treatment duration was associated with higher bleeding rates in HBR (ARD +2.22% [95% CI +0.53 to +3.90]) but not in non-HBR patients (ARD +0.25% [-0.14 to +0.64]; pint = 0.026), and associated with lower ischemic risks in non-HBR (ARD -1.44% [95% CI -2.56 to -0.31]), but not in HBR patients (ARD +1.16% [-1.91 to +4.22]; pint = 0.11). Only non-HBR patients experienced lower net clinical adverse events (NACE) with longer DAPT (pint = 0.043). A 4-item simplified version of the PRECISE-DAPT score retains the potential to categorize patients who benefit from prolonged DAPT without concomitant bleeding liability from those who do not.

• Authors: Francesco Costa, David van Klaveren, Antonio Colombo, Fausto Feres, Lorenz Räber, Thomas Pilgrim, Myeong-Ki Hong, Hyo-Soo Kim, Stephan Windecker, Ewout W Steyerberg, Marco Valgimigli, PRECISE-DAPT Study Investigators
• Journal: American heart journal (Am Heart J) Vol. 223 Pg. 44-47 (05 2020) ISSN: 1097-6744 [Electronic] United States
• PMID: 32151822 (Publication Type: Letter, Randomized Controlled Trial)
• Copyright: Copyright © 2020. Published by Elsevier Inc.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Age Factors
• Clinical Decision-Making
• Dual Anti-Platelet Therapy (standards)
• Duration of Therapy
• Hemorrhage (chemically induced, epidemiology)
• Humans
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Postoperative Complications (chemically induced, epidemiology)
• Risk Assessment