Dual Antiplatelet Therapy (DAPT) Score

The DAPT Score is a clinical prediction tool that helps decide whether a patient should continue dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor, such as clopidogrel, prasugrel, or ticagrelor) beyond 12 months after a percutaneous coronary intervention (PCI) with stent placement, out to 30 months. Unlike bleeding-only tools, it uniquely weighs both ischemic benefit and bleeding harm together in a single score, rather than assessing one risk in isolation.

Development

The score was derived by Yeh et al. (published in JAMA, 2016) from the DAPT Study, a randomized trial of 11,648 patients who had a drug-eluting stent placed and completed 12 months of thienopyridine plus aspirin without an ischemic or bleeding event, then were randomized to either continue thienopyridine plus aspirin for another 18 months or switch to placebo plus aspirin. It was later externally validated in 8,136 patients from the PROTECT trial. Only patients who tolerated the first year without a major event were eligible — those with prior bleeding, MI, stent thrombosis, stroke, revascularization, or on oral anticoagulation were excluded from the derivation population.

Scoring Components

9 factors, range −2 to +10

Notably, age is the only factor that subtracts points — reflecting that older patients tend to have relatively more bleeding risk than ischemic benefit from prolonged therapy — while all other factors add points, reflecting higher ischemic risk.

Interpretation

*Ischemia was defined as MI, stroke, repeat coronary revascularization, or stent thrombosis. Bleeding was defined as intracerebral bleeding, bleeding causing hemodynamic compromise requiring treatment, or bleeding requiring transfusion.

**From ACC guidelines (Levine 2016).

In the derivation cohort, a DAPT score ≥2 was associated with a number needed to treat (NNT) of 33 to prevent one ischemic event, versus a number needed to harm (NNH) of 263 for a bleeding event with prolonged therapy — supporting extended DAPT in that group.

Related/Complementary Score: PRECISE-DAPT

The DAPT score is often used alongside the PRECISE-DAPT score, a separate 5-item bleeding-focused tool (age, creatinine clearance, hemoglobin, white blood cell count, and prior spontaneous bleeding) that ranges from 0–100 points, with ≥25 indicating high bleeding risk favoring a shorter DAPT duration (3–6 months). A simplified 4-item version (dropping WBC count) has also been shown to retain predictive value. Some studies use both scores together — for example, a DAPT score ≥2 combined with a PRECISE-DAPT score <25 has been used to support recommending prolonged DAPT.

Practical note: As with the other scores discussed, the DAPT Score is meant to support — not replace — individualized clinical decision-making, particularly since it was derived from a specific trial population (drug-eluting stent recipients who tolerated the first year of DAPT without complications).

Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention. JAMA. 2016;315(16):1735–1749.