Dual Antiplatelet Therapy (DAPT) Score

DAPT Score

Age

Cigarette Smoking

Diabetes Mellitus

MI at Presentation

Prior PCI or MI

Paclitaxel-Eluting Stent

Stent Diameter <3 mm

CHF or LVEF <30%

Saphenous Vein Graft PCI

DAPT Score: 0

Standard DAPT Duration

Score <2: Standard 12-month DAPT recommended. Bleeding risk may outweigh benefit of extended therapy.

Predicts which patients will benefit from prolonged DAPT after coronary stent placement.

Why Use

Identifies patients that will likely benefit from prolonged DAPT (i.e., from 12–30 months). Assists in evaluating the trade-off between reducing thrombotic events and increasing bleeding risks (predicts a net clinical benefit).

When to Use

Utilize for patients undergoing percutaneous coronary intervention (PCI) with stent placement to determine the optimal duration of dual antiplatelet therapy (DAPT).

Formula

Addition of the selected points: -2 points -1 points 0 points 1 point 2 points Age, years ≥75 65-74 <65 -- -- Cigarette smoking* -- -- No Yes -- Diabetes mellitus -- -- No Yes -- MI at presentation -- -- No Yes -- Prior PCI or prior MI -- -- No Yes -- Paclitaxel-eluting stent -- -- No Yes -- Stent diameter <3 mm -- -- No Yes -- CHF or LVEF <30% -- -- No -- Yes Vein graft stent -- -- No -- Yes *Smoking within 1 year prior to index procedure.

Pearls / Pitfalls

The derivation study did not include patients taking ticagrelor or those on anticoagulation therapy.

Advice

Interpretation based on scores: Lower scores (<2): Associated with a greater risk in bleeding complications and smaller reduction in ischemic events. Prolonged DAPT may cause greater harm than benefit. Higher scores (≥2): Associated with a lower risk in bleeding complications and higher reduction in ischemic events. Prolonged DAPT may provide greater benefit than harm. This tool is not intended to replace clinical judgment; use it as an adjunct to clinical expertise and current cardiology guidelines. Inform patients about the importance of DAPT and involve them in shared decision-making based on their score. Schedule follow-ups to reassess DAPT needs and adjust therapy as necessary.

More Information

Interpretation: DAPT Score Ischemia/bleeding risk* Recommendation** -2 to 1 Low Prolonged DAPT not recommended ≥2 High Prolonged DAPT recommended *Ischemia was defined as MI, stroke, repeat coronary revascularization, or stent thrombosis. Bleeding was defined as intracerebral bleeding, bleeding causing hemodynamic compromise requiring treatment, or bleeding requiring transfusion. **From ACC guidelines, Levine 2016 .