Related Experiment Video
Updated: Oct 6, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Individualizing Dual Antiplatelet Therapy (DAPT) Duration Based on Bleeding Risk, Ischemic Risk, or Both: An Analysis
Nino Mihatov1, Eric A Secemsky2, Dean J Kereiakes3
1Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
Insights
Individualizing dual antiplatelet therapy (DAPT) duration is key. For patients at lower bleeding risk, using ischemic risk or the DAPT score best guides decisions on extending DAPT to optimize outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Current guidelines recommend personalized duration for dual antiplatelet therapy (DAPT).
- The optimal strategy for guiding DAPT duration based on bleeding risk, ischemic risk, or a combined assessment remains unclear.
- This study addresses the uncertainty in DAPT duration individualization for patients with lower bleeding risk.
Purpose of the Study:
- To compare the effectiveness of bleeding prediction models, ischemic prediction models, and the DAPT score in guiding DAPT duration.
- To determine the best risk stratification tool for optimizing DAPT duration in a low-bleeding risk population.
Main Methods:
- 11,648 patients from the DAPT Study were analyzed.
- Patients were stratified into higher and lower risk categories using bleeding models, ischemic models, and the DAPT score.
- The impact of 30 vs. 12 months of DAPT on bleeding, ischemic events, and net-adverse clinical events (NACE) was evaluated.
Main Results:
- The bleeding risk model showed similar ischemic and bleeding event rates for both DAPT durations.
- The ischemic risk model and DAPT score identified high-risk patients benefiting from extended DAPT with greater ischemic event reduction and minimal bleeding increase.
- Extended DAPT significantly reduced NACE in patients identified as high ischemic risk or with a high DAPT score.
Conclusions:
- In a low-bleeding risk population, risk stratification based on predicted ischemic risk and the DAPT score effectively guides decisions on extended DAPT duration.
- These models help discern the balance between ischemic event reduction and bleeding risk when considering longer DAPT regimens.
- Individualized DAPT duration guided by ischemic risk and the DAPT score optimizes clinical outcomes.
Background:
Guidelines recommend individualization of dual antiplatelet therapy (DAPT) duration. Whether to guide decisions based on bleeding risk, ischemic risk or a combination is not known.
Aims:
To compare a bleeding prediction model, an ischemic prediction model, and the DAPT score in guiding DAPT duration.
Methods:
11,648 patients in the DAPT Study were categorized into higher and lower risk using a bleeding model, an ischemic model, and the DAPT score. Effect of 30 vs. 12 months of DAPT on bleeding events, ischemic events, and the combination (net-adverse clinical events [NACE]) was assessed.
Results:
Among patients stratified with the bleeding model, 30 vs. 12 months of DAPT resulted in similar ischemic and bleeding event rates. With the ischemic model, however, higher risk patients had a greater reduction in ischemic events with extended duration of DAPT (difference in risk differences [DRD]: -2.6%, 95% CI: -3.9 to -1.3%; p < 0.01), and a smaller increase in bleeding (DRD: -1.0%, 95% CI: -2.1-0.0%; p = 0.04). Similarly, high DAPT score patients had a greater reduction in ischemic events with extended DAPT duration (DRD: -2.4%, 95%: CI: -3.6 to -1.1%; p < 0.01) and a smaller increase in bleeding (DRD: -1.2%, 95%: CI: -2.2-0.0%; p = 0.02). Although NACE was similar for bleeding risk groups, NACE was significantly reduced with extended DAPT in the higher ischemic risk and high DAPT score groups.
Conclusions:
In this low-bleeding risk population, stratifying patients based on predicted ischemic risk and the DAPT score best discerned benefit versus harm of extended DAPT duration on ischemic events, bleeding events, and NACE.
Condensed Abstract:
Duration of dual antiplatelet therapy (DAPT) should be guided by an individualized risk assessment. Bleeding risk tools have emerged to identify patients at high bleeding risk for whom truncated DAPT therapy may be safest. In a lower bleeding risk population, however, whether DAPT duration should be guided by bleeding risk, ischemic risk, or a combination is unknown. In this analysis, implementation of a score based on ischemic risk prediction and the DAPT score (a combination of ischemic and bleeding risk) best predicted ischemic events, bleeding events, and net-adverse clinical events (NACE).
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Coronary Artery Disease V: Interprofessional Care
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Peripheral Artery Disease III: Interprofessional Care
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:29Venous Thrombosis III: Interprofessional Care