New standardized score identifies patients who should be treated with shorter duration dual-antiplatelet therapy

1. Standardized score suggests that prolonged dual antiplatelet therapy (DAPT) is harmful for patients with low DAPT scores.

2. Prolonged DAPT may reduce risk of ischemic events in patients with high scores receiving paclitaxel-eluting stents.

Evidence Rating Level: 2 (Good)

Study Rundown: The DAPT score is a new, standardized system of predicting which patients will benefit from prolonged DAPT. DAPT involves both aspirin and oral P2Y₁₂ adenosine diphosphate-receptor inhibitors, and is currently recommended in guidelines as standard of care for patients with coronary artery disease undergoing percutaneous coronary intervention. Despite the evidence to support DAPT, not all patients benefit from prolonged therapy and the relationship between the DAPT score and safety of DAPT duration are currently unclear. Therefore, the authors of this study aimed to assess the efficacy and safety of prolonged DAPT based on DAPT score. In general, it was observed that prolonged DAPT is not beneficial for patients with a low DAPT score. This study has several limitations. First, while the variables were included in the DAPT score were collected prospectively, the score had to be calculated retrospectively as it was not available at the time of collection. Additionally, risk estimates were imprecise as few ischemic events occurred in general.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Antiplatelet therapy: New score for predicting bleeding risk after DAPT

In-Depth [retrospective cohort]: In this retrospective assessment of DAPT score,1970 patients undergoing percutaneous coronary intervention (PCI) were included in the study. The primary outcomes measured consisted of death, myocardial infarction, or cerebrovascular accident and were assessed at 6 versus 24 months. Safety was also assessed as type 3 or 5 bleeding, based on the Bleeding Academic Research Consortium’s definition. Generally, the primary safety outcome was higher in patients with low DAPT scores for 24 months compared to 6 months (risk difference [RD] for score ≥ 2, 0.20 percentage point [CI, -1.20 to 1.60 percentage points]; RD for score < 2, 2.58 percentage points [CI, 0.71 to 4.46 percentage points]; p = 0.046). Additionally, a greater reduction in primary efficacy outcome was observed with 24- compared to 6-month DAPT for patients with high DAPT scores. Primary efficacy of DAPT also varied by stent type. For example, prolonged DAPT with patients with high scores was effective in those that received paclitaxel-eluting stents (RD for score ≥ 2, 0.20 percentage point [CI, -1.20 to 1.60 percentage points]). In contrast, the benefit of DAPT is still unclear in patients receiving contemporary drug-eluting stents.

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