Dual Antiplatelet Therapy (DAPT) Score

Why did you develop the DAPT Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

The question of how long to continue antiplatelet therapy after coronary stent procedures has troubled physicians for many years. On one hand, continuing these medications can prevent heart attacks. On the other hand, the drugs can also lead to bleeding. We wanted to develop a tool that could help clinicians identify who were the best patients to continue long term antiplatelet medications after heart stents, and who were the patients best served by shorter durations of these medications.  

What pearls, pitfalls and/or tips do you have for users of the DAPT Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

The DAPT Score gives clinicians an opportunity to see how patients with particular characteristics fared when randomized to either 30 months or 12 months of dual antiplatelet therapy after receiving a stent. The data are based on the largest ever randomized blinded trial of antiplatelet therapy that we led at the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute). However, although this is high quality evidence that has made its way into national guidelines, the DAPT Score is meant to be used in conjunction with clinical judgment. In addition, the score was derived in patients who were not taking long term oral anticoagulants like Coumadin and had no history of major bleeding in the past.

What recommendations do you have for doctors once they have applied the DAPT Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

The DAPT Score should be used to guide antiplatelet duration in conjunction with clinical judgment and applied on an individualized basis. It is not a substitute for clinical judgment. It has been validated across a number of different populations, and continues to perform well in multiple settings in terms of separating patients with high ischemic/low bleeding risk (better served with longer durations of antiplatelet medications) from other patients with low ischemic/high bleeding risk (better served with shorter durations of antiplatelets).

How do you use the DAPT Score in your own clinical practice? Can you give an example of a scenario in which you use it?

We use the DAPT Score to aid in discussions with patients and their referring physicians about the proper duration of antiplatelet therapies each day. In the office, using an app is particularly valuable for patients to see what their risks are and to give context to shared decision making around this common conundrum.

Robert W. Yeh, MD, is an associate professor of medicine at Harvard Medical School. He is also director of the Richard and Susan Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center. Dr. Yeh’s primary research interests revolve around improving the value of coronary and vascular devices and therapies in clinical practice.