Bleeding-risk calculator could help determine how long to continue DAPT

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Takeaway

  • PRECISE-DAPT, a new bleeding risk calculator available online and as an application, uses age, creatinine clearance, white-blood-cell count, Hb, and history of bleeding to predict out-of-hospital bleeding in patients treated with dual antiplatelet therapy (DAPT).

Why this matters

  • A standardized bleeding risk-assessment tool would help clinicians determine the most appropriate DAPT treatment duration for patients after coronary stent implantation via percutaneous coronary intervention (PCI).

Study design

  • 14,590 patients pooled from 8 multicenter, randomized trials who underwent PCI for coronary stent implantation with subsequent DAPT.
  • External validation with patients from PLATO trial (n=8595) and BernPCI Registry (n=6172).
  • Funding: None.

Key results

  • Bleeding risk predictors with P<.10 were identified from randomized trials (age, creatinine clearance, Hb, white-blood-cell count at baseline, and previous spontaneous bleeding).
  • A risk score using these 5 items, PRECISE-DAPT, showed a c-index of 0.73 for out-of-hospital major or minor bleeding and 0.71 for major bleeding within 12 mo of stenting.
  • In validation cohort, c-indices for out-of-hospital major or minor bleeding were 0.70 in PLATO and 0.66 in BernPCI registry.

Limitations

  • Frailty not included in the risk calculator.
  • Unknown if risk score would be effective in unselected patients.