Healthcare & Clinical
DAPT Score (Yeh 2016) Prolonged Dual Antiplatelet Therapy Formula (-2 to +10)
Calculate Robert Yeh’s ACC/AHA-endorsed DAPT Study Score (-2 to +10 points) after 12 event-free months post-coronary stenting—balancing older-age bleeding penalty (-2 or -1) against 8 ischemic stent-thrombosis predictors (+1 or +2) around the >= 2 continuation cutoff.
Weigh late stent-thrombosis protection against major bleeding after 12 event-free months of DAPT!
Once a coronary PCI stent patient completes 12 months of aspirin + P2Y12 inhibitor without experiencing major bleeding or recurrent ischemia, should dual antiplatelet therapy (DAPT) stop at 12 months (aspirin monotherapy) or continue to 30 months? Robert Yeh et al. (2016, JAMA) derived the ACC/AHA-endorsed DAPT Score (range -2 to +10) from the 11,648-patient randomized DAPT Trial to quantify net ischemic-minus-bleeding benefit!
Notice how Age is the ONLY negative bleeding-penalty variable (Age >= 75 yr = -2 points; Age 65 to 74 yr = -1 point; Age < 65 yr = 0 points), weighed against eight ischemic risk factors: Current cigarette smoking (+1), Diabetes mellitus (+1), MI at index presentation (+1), Prior PCI or prior MI (+1), Paclitaxel-eluting stent (+1), Stent diameter < 3.0 mm (+1), Congestive heart failure or LVEF < 30% (+2), and Saphenous vein graft (SVG) stent (+2)! Patients with DAPT Score >= 2 achieved a 8.2-to-1 ratio of ischemic MACE reduction (-2.7% ARR) over GUSTO moderate/severe bleeding (+0.4%), favoring prolonged 30-month DAPT—whereas Score < 2 showed excess bleeding (+1.5%) with minimal ischemic gain, favoring discontinuation to aspirin alone at 12 months!
| DAPT Score Component (12 Months Post-PCI, Event-Free) | Points Assigned | Clinical Regimen Decision |
|---|---|---|
| Patient Age (Bleeding Penalty) | >= 75 yr (-2), 65–74 yr (-1), < 65 yr (0) | Total Possible Range: -2 to +10 |
| 6 One-Point Ischemic Predictors | Smoking, DM, Index MI, Prior PCI/MI, PES, Stent < 3mm | +1 Point Each |
| 2 Two-Point High-Risk Predictors | CHF or LVEF < 30% (+2), Vein Graft PCI (+2) | >= 2 Favor Prolonged DAPT; < 2 Stop at 12m |
Total Yeh (2016) DAPT Study Score (-2 to +10 Points)
Combines the age bleeding penalty (B2) with six +1 ischemic predictors (B3:B8) and two +2 predictors (B9:B10).
=IF(B2 < 18, "Invalid Adult Age", IF(B2 >= 75, -2, IF(B2 >= 65, -1, 0)) + SUM(B3:B8) + 2 * SUM(B9:B10))ACC / AHA 12-Month vs. 30-Month DAPT Regimen Recommendation
Applies the validated DAPT Score >= 2 cutoff favoring prolonged P2Y12 continuation vs. < 2 favoring standard 12-month cessation.
=IF(B2 < 18, "Invalid Adult Age", IF((IF(B2 >= 75, -2, IF(B2 >= 65, -1, 0)) + SUM(B3:B8) + 2 * SUM(B9:B10)) >= 2, "DAPT Score >= 2: Net Ischemic Benefit — Favor Prolonged DAPT (30 mo)", "DAPT Score < 2: Excess Bleeding Risk — Favor Standard 12-mo Discontinuation"))Try the example
Use the original values or change them to test your understanding.