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  • Editorial: Cautionary Tale or Exploratory Trek — Predicting Mortality Using the DAPT Score

    The recognition in the 1990s that antiplatelet therapy with aspirin and a P2Y12 antagonist was crucial for maintaining early stent patency, coupled with the recognition that the risk factors for bleeding and for thrombosis shared many common features led to the development of indices designed to facilitate decision making with regard to the duration of antithrombotic therapy. Perhaps the most widely reported of these indices has been the DAPT score, first published by Yeh et al. in 2016. This score was derived from the Dual Antiplatelet Trial (DAPT), which compared a 12 month versus 30 month course of aspirin and a thienopyridine in patients who had undergone intracoronary stenting. Integer points were assigned to nine readily assessable characteristics, each of which was weighted with either one or two points, and these values were summed to result in a final prediction score. Age was weighted with a negative score, indicating a greater risk of bleeding than thrombotic events in elderly patients who were treated with antithrombotic drugs. Interaction with treatment assignment (12 vs 30 month DAPT) indicated that a value of 2 was a cutpoint separating patient at high versus low risk for myocardial infarction or stent thrombosis. Patients with scores <2, who received prolonged DAPT experienced more bleeding but no reduction in ischemic events compared with patients assigned to single antiplatelet therapy, while those with scores ≥2 experienced similar bleeding but fewer ischemic events when they were assigned to prolonged DAPT. Although all-cause mortality was higher in patients with scores >2, stratification by score quartiles was not associated with progressive increases in mortality.

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