Comprehensive Guide to Bleeding Risk Assessment in Dual Antiplatelet Therapy
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).
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the standard of care following PCI. However, determining optimal DAPT duration requires balancing:
PRECISE-DAPT provides an evidence-based approach to personalize DAPT duration by:
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.
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 |
Score: 0-15
Recommendation: Standard DAPT duration (12 months)
Score: 16-24
Recommendation: Standard DAPT with careful monitoring
Score: ≥25
Recommendation: Consider shorter DAPT (3-6 months)
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 |
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