A systematic review of the studies that evaluate the performance of the DAPT score

Kwok, Chun Shing; Wong, Chun Wai; Nagaraja, Vinayak; Mamas, Mamas A.

doi:10.1111/ijcp.13591

Cited by 8 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current focus on DAPT-scoring systems may eventually assist in this process. Still, in the short term, the proliferation in competing systems for risk definition and inconsistent outcomes has added a further complexity level [5,[9][10][11][12]. Considering that the risk of bleeding is higher and the risk of ischemic events is lower in Asians than in non-Asians [13,14], the balance between ischemic and bleeding events in Japan appears to be different from that in other countries.…”

Section: Introductionmentioning

confidence: 99%

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Yokoi

Oda²,

Kaneko³

et al. 2022

Cardiovasc Interv and Ther

View full text Add to dashboard Cite

In this real-world, retrospective cohort study of 9753 patients in Japan prescribed dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), we investigated DAPT duration and determined factors associated with early DAPT discontinuation and with event rates in patients who discontinued DAPT. The study period was April 1, 2012–March 31, 2018; endpoints comprised composite efficacy [death, myocardial infarction (MI), and stroke] and bleeding (intracranial, gastrointestinal, and requiring transfusion) endpoints. Overall, 68.8% of patients were continuing DAPT at 3 months post-PCI. Patients without major efficacy or safety events within 3 months after index PCI were included in a landmark analysis set (LAS; n = 7056), and categorized as DAPT ≥ 3 months (continuation) versus < 3 months (discontinuation). In the two LAS analysis groups, there was no difference in the composite bleeding endpoint (P = 0.067), although the incidence of the composite efficacy endpoint was higher in the discontinuation group (P < 0.001). In multivariate regression analysis, age ≥ 75 years, minor bleeding after PCI, history of cerebral infarction, history of cerebral or gastrointestinal bleeding, atrial fibrillation, dialysis, and anticoagulant use after PCI were associated with early DAPT discontinuation. Acute coronary syndrome, history of MI, kidney disorder, and anticoagulant use after PCI were associated with the composite efficacy endpoint in the discontinuation group. In conclusion, early DAPT discontinuation is more likely in patients at high bleeding risk, but may influence the occurrence of ischemic events in these patients. Determination of DAPT duration should take into account potential ischemic risk, even in patients at high bleeding risk.

show abstract

Section: Introductionmentioning

confidence: 99%

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Yokoi

Oda²,

Kaneko³

et al. 2022

Cardiovasc Interv and Ther

View full text Add to dashboard Cite

show abstract

“…The prediction rule assigns 1 point each for myocardial infarction at presentation, prior myocardial infarction or PCI, diabetes, stent diameter less than 3 mm, smoking, and paclitaxel-eluting stent; 2 points each for history of congestive heart failure/Low ejection fraction and vein graft intervention; −1 point for age 65 to younger than 75 years; and −2 points for age 75 years or older[ 21 ]. The DAPT score has been validated in several studies outside its derivation cohort; however, these studies have yielded conflicting results in which some have confirmed its predictive value and some have not[ 22 ]. Of note, most of the analyses were from registries and a substantial number of patients were treated with bare-metal stents or first-generation DES.…”

Section: Resultsmentioning

confidence: 99%

“…In the PRECISE-DAPT score, eGFR < 30 mL/min by itself increases patients bleeding risk to the highest quartile, whereas milder CKD is associated with a slight to moderate risk. It must be noticed that in the DAPT score, CKD is not considered as a variable because the associated increased bleeding risk was balanced by an almost identical increased ischemic risk[ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Untangling the difficult interplay between ischemic and hemorrhagic risk: The role of risk scores

Persampieri¹,

Castini²,

Lupi³

et al. 2022

WJC

View full text Add to dashboard Cite

BACKGROUND Bleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention. This represents a hazard equivalent to or greater than that for recurrent ACS. Dual antiplatelet therapy (DAPT) represents the cornerstone in the secondary prevention of thrombotic events, but the benefit of such therapy is counteracted by the increased hemorrhagic complications. Therefore, an early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients. AIM To review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease (IHD). METHODS We used a combination of terms potentially used in literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed as well as references of full-length articles. RESULTS In this review we briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD, focusing on GRACE, CHA2DS2-Vasc, PARIS CTE, DAPT, CRUSADE, ACUITY, HAS-BLED, PARIS MB and PRECISE-DAPT score. In the second part of this review, we try to define a possible approach to the IHD patient, using the most suitable scores to stratify patient risk and decide the most appropriate patient treatment. CONCLUSION It becomes evident that risk scores by themselves can’t be the solution to balance the ischemic/bleeding risk of an IHD patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.

show abstract

“…For the benchmark, two validated scores (i.e., the DAPT score and the PRECISE-DAPT score) that are extensively applied in clinical studies (35, 36), served as the potential candidates. The PRECISE-DAPT focuses mainly on forecasting the out-of-hospital bleeding risk, while the DAPT score was dedicated to estimating the incidence probabilities of both events, which matches our prediction task.…”

Section: Methodsmentioning

confidence: 99%

AI-aided dynamic prediction of bleeding and ischemic risk after coronary stenting and subsequent DAPT

Rasmy

Yang

Feng

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Contemporary risk scores for ischemic or bleeding event prediction after drug-eluting stent (DES) implantation are limited to the determination of single time duration for dual antiplatelet therapy (DAPT) and lack flexibility in providing dynamic risk stratification. Objectives This study sought to develop artificial intelligence (AI) models to dynamically predict the ischemic and bleeding risks at different time intervals for patients with DES implantation for personalized decision support for antiplatelet therapy. Methods We identified 81,594 adult patients who received DES implantation in the United States from the Cerner HealthFacts; dataset. The total prediction window covered 12-30 months after DES implantation. We designed eight prediction scenarios with four prediction intervals (3, 6, 12, and 18 months). Five AI models were developed for the ischemic and bleeding risk stratification. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC). Results Our proposed AI model outperformed the clinical guideline-recommended tool--the DAPT score--for 12m-30m prediction (with AUROC 0.82 vs. 0.79 for ischemia, 0.77 vs 0.72 for bleeding). In the scenarios that are not covered by the DAPT score, our models demonstrated robust performance (AUROC ranges were 0.79-0.80 for ischemia and 0.75-0.76 for bleeding). Conclusions As the first effort dedicated to dynamically forecasting adverse endpoints after DES implantation given DAPT continuation or discontinuation, our AI-empowered approach demonstrates superior capabilities for risk stratification, holding value as a novel clinical tool that can refine the prognostic judgments of clinicians and achieve optimal DAPT management.

show abstract

A systematic review of the studies that evaluate the performance of the DAPT score

Cited by 8 publications

References 26 publications

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Duration and clinical outcome of dual antiplatelet therapy after percutaneous coronary intervention: a retrospective cohort study using a medical information database from Japanese hospitals

Untangling the difficult interplay between ischemic and hemorrhagic risk: The role of risk scores

AI-aided dynamic prediction of bleeding and ischemic risk after coronary stenting and subsequent DAPT

Contact Info

Product

Resources

About