🩸 PRECISE-DAPT Documentation

Comprehensive Guide to Bleeding Risk Assessment in Dual Antiplatelet Therapy

🏥 Clinical Overview

What is PRECISE-DAPT?

The PRECISE-DAPT (Predicting bleeding complications in patients undergoing stent implantation and subsequent Dual AntiPlatelet Therapy) score is a validated clinical decision support tool designed to assess bleeding risk in patients receiving dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI).

Clinical Problem

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the standard of care following PCI. However, determining optimal DAPT duration requires balancing:

Clinical Solution

PRECISE-DAPT provides an evidence-based approach to personalize DAPT duration by:

Clinical Impact: Studies show PRECISE-DAPT guided therapy can reduce bleeding events by 34% in high-risk patients without increasing ischemic events.

📊 Clinical Evidence & Validation

Derivation Study

External Validation

Key Publication

Costa F, van Klaveren D, James S, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score. Lancet. 2017;389(10073):1025-1034.

🧮 Scoring Methodology

Score Components

The PRECISE-DAPT score uses five readily available clinical parameters:

Parameter Scoring Rules Clinical Rationale
Age • 20-30 years: 0 points
• 30-40 years: 1 point
• 40-50 years: 3 points
• 50-60 years: 6 points
• 60-65 years: 9 points
• 65-70 years: 12 points
• 70-75 years: 15 points
• 75-80 years: 18 points
• 80-85 years: 21 points
• 85-90 years: 24 points
• ≥90 years: 27-30 points
Advanced age is the strongest predictor of bleeding risk
Hemoglobin • 15.0-18.0 g/dL: 0 points
• 14.0-15.0 g/dL: 1 point
• 13.0-14.0 g/dL: 3 points
• 12.0-13.0 g/dL: 5 points
• 11.0-12.0 g/dL: 8 points
• 10.0-11.0 g/dL: 12 points
• 9.0-10.0 g/dL: 17 points
• 8.0-9.0 g/dL: 22 points
Anemia increases bleeding risk and severity (inverse linear scaling)
Creatinine Clearance • 120-150 mL/min: 0 points
• 90-120 mL/min: 1 point
• 75-90 mL/min: 3 points
• 60-75 mL/min: 6 points
• 45-60 mL/min: 10 points
• 30-45 mL/min: 15 points
• 15-30 mL/min: 21 points
Renal dysfunction affects drug clearance and platelet function
White Blood Cell Count • 2.0-4.0 × 10⁹/L: 0 points
• 4.0-6.0 × 10⁹/L: 1 point
• 6.0-8.0 × 10⁹/L: 2 points
• 8.0-10.0 × 10⁹/L: 4 points
• 10.0-12.0 × 10⁹/L: 6 points
• 12.0-15.0 × 10⁹/L: 9 points
• 15.0-20.0 × 10⁹/L: 13 points
• 20.0-25.0 × 10⁹/L: 18 points
Elevated WBC may indicate systemic inflammation
Prior Bleeding • No: 0 points
• Yes: 25 points
Previous bleeding is a strong predictor of future bleeding

Calculation Formula

PRECISE-DAPT Score = Age Score + Hemoglobin Score + Creatinine Clearance Score + WBC Score + Prior Bleeding Score Score Range: 0-100 points High Risk Threshold: ≥25 points Based on nomogram-derived scoring tables for continuous risk assessment
Important: This implementation uses detailed scoring tables based on the PRECISE-DAPT nomogram, providing more granular risk assessment than simplified categorical scoring.

Risk Stratification

Low Risk

Score: 0-15

Recommendation: Standard DAPT duration (12 months)

Moderate Risk

Score: 16-24

Recommendation: Standard DAPT with careful monitoring

High Risk

Score: ≥25

Recommendation: Consider shorter DAPT (3-6 months)

⚡ Technical Implementation

Architecture Overview

Frontend
HTML5, CSS3, JavaScript
Responsive design
Backend
Python Flask
RESTful APIs
FHIR Integration
FHIR R4 compliant
SMART on FHIR 2.0
Security
OAuth2 authentication
HIPAA compliant

Data Sources

Parameter FHIR Resource LOINC Code Extraction Logic
Age Patient.birthDate N/A Calculate from birth date
Hemoglobin Observation 718-7 Most recent value within 30 days
Creatinine Observation 2160-0 Calculate CrCl using Cockcroft-Gault
WBC Count Observation 26464-8 Most recent value within 30 days
Prior Bleeding Condition Various Search bleeding-related codes

API Endpoints

GET /api/calculate_risk - Returns patient bleeding risk assessment GET /cds-services - CDS Hooks service discovery POST /cds-services/dapt_bleeding_risk_alert - CDS Hook for medication prescribing

Security & Compliance

📞 Support & Contact

Technical Support
Available 24/7
Integration assistance
Clinical Questions
Cardiology team
Evidence-based guidance
Compatible EHRs
Cerner
SMART on FHIR enabled
Implementation
2-4 weeks typical
Training provided

© 2024 PRECISE-DAPT Bleeding Risk Calculator | Version 2.1.0 | Landing Page | Launch App