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

American Heart Journal
Francesco CostaPRECISE-DAPT Study Investigators

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.

Citations

Sep 18, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Felice GragnanoUNKNOWN GLASSY Investigators
Jan 31, 2021·European Heart Journal·Niels M R van der SangenWouter J Kikkert
Mar 3, 2021·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Xiaoying LiYaling Han
Mar 26, 2021·IJC Heart & Vasculature·Lisa DannenbergAmin Polzin
Oct 11, 2020·Cardiology Clinics·Francesco CostaLuigi Fimiani
Oct 7, 2021·Journal of the American Heart Association·Axel WesterSasha Koul

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