AHA: DAPT score helps decide whether DAPT continues

The DAPT score is a clever and innovative idea. It is a major step forward in helping clinicians decide which patients should continue dual antiplatelet therapy after safely completing a year on this therapy following percutaneous coronary intervention. The DAPT score was data driven and provides a tool to help personalize decision making with a simple, practical solution to a common clinical dilemma. It’s a welcome addition to our decision-making process.

The competing risks from bleeding events caused by continued dual antiplatelet therapy (DAPT) beyond 1 year and ischemic events caused by stopping DAPT creates difficulty in determining whether or not to continue or stop DAPT for an individual patient. The DAPT score helps make that decision.

Mitchel L. Zoler/Frontline Medical News Dr. James de Lemos

The analysis performed by Dr. Yeh and his associates produced a clear and convincing result. The primary caveat is that it is only applicable to patients who entered the randomized phase of the DAPT study, specifically patients who underwent a full first year of DAPT treatment following PCI without an ischemic or major bleeding event. I would like to see replication of the score’s validation in an additional data set, although few data sets exist that are suitable for such replication. Although the discrimination produced by the DAPT score is moderate, it compares favorably with other widely used clinical decision scores such as the CHA2ADS2-VASc.

The added decision-making ability facilitated by this score revises my interpretation of the results from the DAPT study. When the results of the trial appeared in 2014, I considered the outcome null because of the problem it highlighted in balancing the competing risks of ischemic and bleeding events when deciding about continuing DAPT beyond 1 year. The DAPT score helps produce a much clearer risk versus benefit decision for a sizable subset of patients who undergo percutaneous coronary intervention.

Dr. James de Lemos is a professor of medicine at UT Southwestern Medical Center, Dallas, and chief of the cardiology service at Parkland Memorial Hospital in Dallas. He has received honoraria from Novo Nordisk and St. Jude and research funding from Roche Diagnostics and Abbott Diagnostics. He made these comments as the designated discussant for Dr. Yeh’s report.