The DAPT score does fine as a risk assessment for extended dual antiplatelet therapy (DAPT) — but like similar tools, the real question is whether it is even used, clinicians said.
“From a methodologic standpoint, the construction of this score represents an elegant solution to a complicated problem: quantifying both benefits and harms from a therapeutic intervention into a singular metric from which clinical decisions can be based,” Roxana Mehran, MD, and Usman Baber, MD, both of Mount Sinai Medical Center in New York City, wrote in a commentary online in JAMA Cardiology.
But the score failed to include certain “well-established correlates” like bleeding and body mass index, the duo noted. In addition, the DAPT trial that was the basis for the score did not enroll patients requiring triple therapy. Also, inherent in this tool is the assumption that thrombosis and bleeding are opposite and comparable risks, they added.
“These limitations notwithstanding, the DAPT score provides a timely and intuitive tool to inform a very important clinical decision. Certainly other scores will also be developed, and numerous studies will compare them in an effort to refine the decision-making process.”
“However, as clinical investigators, it is critical that we do not lose sight of the forest from the trees and realize that, without implementation, the development of such scores alone will not improve the outcomes of our patients. To this end, it is sobering that only 30% to 40% of physicians use well-validated and long standing risk scores as part of routine clinical care,” Mehran and Baber wrote.
“So for now, the clinician’s evaluation of the patient remains paramount in the decision-making process, and although the risk scores are a great tool, their application will always be in the context of the clinician’s perspective.”
Mehran declared receiving research grant support from Eli Lilly/Daiichi Sankyo, Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, and CSL Behring; and has worked as a consultant for Janssen Pharmaceuticals, Osprey Medical, Watermark Research Partners, and Medscape; is on the scientific advisory board of Abbott Laboratories and has given lectures sponsored by PlatformQ and Sanofi; and was also on the committee and data safety monitoring board of Covidien and Forest Laboratories and has stock or stock options in Claret Medical and the Elixir Medical Corporation.
Mehran R, et al “Predicting risk of ischemic or bleeding events after percutaneous coronary intervention” JAMA Cardiol 2016; DOI: 10.1001/jamacardio.2016.2190.