Provision of a DAPT Score to Cardiologists and Extension of Dual Antiplatelet Therapy Beyond 1 Year After ACS:...

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) after acute coronary syndrome reduces ischemic events but increases bleeding risk.
• The DAPT score stratifies patients for benefit or harm from extending therapy beyond one year.
• Non-ST-segment elevation myocardial infarction (NSTEMI) patients require careful consideration for DAPT duration.

Purpose of the Study:

• To evaluate if providing the DAPT score to physicians impacts decisions on extending DAPT beyond one year in NSTEMI patients.
• To assess the real-world effect of a clinical decision support tool on DAPT management.

Main Methods:

• An exploratory randomized trial involving 52 cardiologists and 585 NSTEMI patients across 13 Canadian hospitals.
• Cardiologists were randomized to receive patient-specific DAPT scores before the 1-year follow-up or not.
• Rates of DAPT extension were compared between the intervention and control groups.

Main Results:

• DAPT was extended beyond one year in 36.2% of patients in the DAPT score provision arm versus 35.7% in the control arm (P=0.93).
• In patients with a DAPT score ≥ 2, extension rates were 49.5% vs. 40.4% (P=0.22).
• In patients with a DAPT score < 2, termination rates were 78.6% vs. 70.6% (P=0.26), with no significant interaction.

Conclusions:

• Provision of the DAPT score to treating physicians did not significantly alter the duration of DAPT treatment beyond one year in NSTEMI patients.
• The study suggests that the DAPT score, while informative, did not change clinical practice in this randomized setting.
• Further research may be needed to explore barriers to score implementation or alternative strategies for optimizing DAPT duration.