Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials

This paper describes PRECISE-DAPT score, a simple 5-item risk score (age, creatinine clearance, haemoglobin, white-blood-cell count, previous spontaneous bleeding), which provides a standardised tool for prediction of out-of-hospital bleeding during dual antiplatelet therapy.

According to the researchers, the PRECISE-DAPT score is a simple bedside risk assessment tool, which can be easily implemented in everyday clinical practice, and that might be particularly useful for its applicability at the time of treatment initiation, They reported that the score showed potential to identify patients at high bleeding risk (score ≥25) who might benefit from a shortened (i.e. <12 months) dual antiplatelet therapy (DAPT) duration. Patients not at high bleeding risk (score <25) might receive a standard (i.e. 12 months) or prolonged (i.e. >12 months) treatment without being exposed to significant bleeding liability.

 

A commentary notes that “categorising a patient as having high bleeding risk is challenged by the notion that the risk for bleeding is dynamic and might change over time, a process that cannot necessarily be accounted for when limited to in-hospital criteria. As such, clinicians must remain aware and vigilant that risk scores, like PRECISE-DAPT, although useful to improve the accuracy of the prognostic assumptions affecting clinical decisions, cannot be considered a clear-cut decision rule or a substitute for case-by-case critical judgment.”