4-item PRECISE-DAPT score good enough to predict bleeding risk in patients on DAPT

Researchers have found that a simplified 4-item PRECISE-DAPT score excluding WBC maintains the capability to categorize patients who benefit or not from prolonged DAPT. The study has been published in the American Heart Journal.

The PRECISE-DAPT score is a 5-item bleeding risk prediction tool developed for patients treated with dual antiplatelet therapy. By stratifying patients according to the baseline bleeding risk, PRECISE-DAPT has shown the potential to inform decision-making for DAPT duration after percutaneous coronary intervention.

Dual antiplatelet agents are given after PTCA and stenting to avoid ischemia and stent thrombosis. It is seen that in many patients it causes bleeding and prolonged DAPT causes more harm. Five items DAPTscore was developed where we can find out the patients who will be harmed. by prolonged DAPT.Now the researchers have omitted the WBC count and found that four-item ie AGE, GFR, Hb and prior bleeding history are enough to diagnose patients at high risk of bleeding with prolonged DAPT.

A simplified version of this score lacking white blood cells count (WBC) and therefore based on 4 factors (i.e. age, hemoglobin, creatinine clearance, prior bleeding requiring medical attention) has been previously generated, showing only minimal discrimination or calibration losses as compared to the 5-item iteration in both the generation and validation datasets.

Researchers conducted an analysis to test whether this simplified version of the score helps categorizing patients at high bleeding risk (HBR) who should receive shortened DAPT after PCI.

The researchers assessed the impact of the randomly allocated short and long DAPT durations on bleeding (i.e. TIMI major or minor definition), ischemic events (i.e. composite of myocardial infarction, stent thrombosis, stroke or target vessel revascularization), and net adverse clinical events (NACE, i.e. the combination of aforementioned ischemic and bleeding events) across the simplified 4-item PRECISE-DAPT score quartiles (i.e. very-low ≤7 points, low 8 to 15 points, moderate 16 to 24 points, high ≥25 points). Interaction between high (highest quartile) versus non-high (lowest three quartiles) 4-item PRECISE DAPT score and DAPT duration was evaluated by assessing heterogeneity for absolute risk differences. All analysis was performed with R version 3.6 (R Foundation, Vienna, Austria), and a P <.05 was considered for statistical significance.

The investigators found that a simplified 4-item PRECISE-DAPT score (i.e. excluding WBC) may prove useful to support clinical decision-making for DAPT duration.

They concluded that a simplified 4-item PRECISE-DAPT score excluding WBC maintains the capability to categorize patients who benefit or not from prolonged DAPT, and may offer an alternative solution for risk stratification and decision making purposes in settings where WBC is not available.

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