PRECISE-DAPT Documentation - Clinical Evidence & Implementation Guide

Overview Clinical Evidence Scoring Implementation ← Back to Landing

🏥 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:

Ischemic Risk: Shorter DAPT may increase risk of stent thrombosis
Bleeding Risk: Longer DAPT increases risk of major bleeding events

Clinical Solution

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

Identifying patients at high bleeding risk who may benefit from shorter DAPT
Supporting standard DAPT duration in low-risk patients
Enabling informed shared decision-making

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

Population: 14,963 patients from 8 randomized controlled trials
Primary Endpoint: TIMI major or minor bleeding at 1 year
C-statistic: 0.73 (excellent discriminative ability)
Calibration: Excellent across all risk categories

External Validation

Population: 8,595 patients from 3 additional randomized trials
C-statistic: 0.72 (maintained excellent performance)
Geographic Validation: Tested across multiple countries

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

HIPAA Compliant: Secure data handling
No Persistent Storage: Patient data not retained
Audit Logging: Complete access trail
Encrypted Transport: HTTPS only

📞 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

🩸 PRECISE-DAPT Documentation