This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
After a coronary stent, patients take two antiplatelet drugs, aspirin plus a P2Y12 inhibitor such as clopidogrel, ticagrelor or prasugrel. This dual antiplatelet therapy (DAPT) protects the stent and the rest of the coronary tree, but it also raises the risk of bleeding. The DAPT trial showed that continuing it beyond 12 months cut heart attacks and stent thrombosis but increased bleeding. The DAPT score, published by Yeh and colleagues in 2016, identifies the patients in whom the benefit is likely to win.
The points
| Item | Points |
|---|---|
| Age 75 or older | -2 |
| Age 65 to 74 | -1 |
| Current cigarette smoking | +1 |
| Diabetes | +1 |
| Myocardial infarction at presentation | +1 |
| Prior PCI or prior myocardial infarction | +1 |
| Paclitaxel-eluting stent | +1 |
| Stent diameter under 3 mm | +1 |
| Heart failure or ejection fraction under 30% | +2 |
| Stent in a vein graft | +2 |
Age lowers the score because older patients bleed more. Most other items raise the risk of new ischemic events, and so the benefit of continuing treatment.
Example
A 58-year-old smoker (+1) treated for a heart attack (+1) scores 2. The score favors continuing dual antiplatelet therapy past 12 months, if he has had no bleeding in the first year.
Interpretation
| Score | Meaning |
|---|---|
| 2 or more | ischemic benefit likely greater than bleeding risk: prolonged DAPT can be considered |
| under 2 | bleeding risk likely greater than benefit: stop the second antiplatelet at 12 months |
In the trial, patients with a score of 2 or more had fewer heart attacks and stent thromboses with prolonged treatment, with a modest rise in bleeding. Those under 2 had more bleeding and little ischemic benefit.
When to use it
The score applies to patients who have completed 12 months of dual antiplatelet therapy without a major bleed or ischemic event. It is not meant to decide the first year of treatment. Paclitaxel stents are now rarely used, but the item is kept because the score was validated with it.
Limits
The decision also depends on anemia, kidney disease, the need for anticoagulation and the patient’s preferences. Guidelines now often favor shorter therapy in high bleeding risk patients. Never stop or extend antiplatelet drugs without talking to your cardiologist.