Since the development of the first bare metal (BMS) and drug-eluting stents (DES), the literature and guidelines have debated how long to continue dual antiplatelet therapy (DAPT). The most recent guidelines and data seemed to suggest that less is more.
Currently, the recommendation is for at least 30 days of DAPT after a BMS, and at least 6 months after a DES; the guidelines were less clear about DAPT beyond 12 months. The benefits of longer DAPT include a lower risk of stent thrombosis/myocardial infarction (MI) and major adverse cardiovascular (CV) and cerebrovascular events, but a greater risk of moderate to severe bleeding.
In 2016, the was published in the Journal of the American Medical Association, which included a DAPT calculator to assist providers in making decisions about prolonged DAPT. If a DAPT score is less than 2, patients probably should just receive aspirin, but if 2 or greater they should consider continuing DAPT out to an additional 18 months (30 months total).
The DAPT study yielded a number needed to treat (NNT) of 30 for prevention of one additional CV event over aspirin alone without a significant increase in bleeding. The DAPT calculator helps to tease out those who would benefit most versus those whose bleeding risk likely exceeds any benefit.
The DAPT calculator is available online and is also available in various existing medical calculator apps, including Qx Calculate and MedCalx. Now the American College of Cardiology (ACC) has published their version of the DAPT calculator.
The ACC already has an outstanding app called Anticoag Evaluator that helps providers and patients calculate the need for oral anticoagulation, while comparing the risks/benefits of the various treatments side-by-side. Now they have developed a similar app for DAPT, which is based on the DAPT calculator published in JAMA. Additionally, the app links to the current ACC guidelines related to the topic and various DAPT updates published by the ACC. The app takes the published data and the validated calculator in a very user-friendly point-of-care app.
Clinical Scenario
A 65-year-old male with a medical history of hypertension and type 2 diabetes underwent placement of a DES after suffering an MI. The patient has completed the minimal recommended DAPT with aspirin and clopidogrel. Should he receive prolonged DAPT up to 30 months? What if the patient was 75 years old?
Video Review of ACC DAPT App
to iMedicalApps in order to view the following video review of ACC DAPT Risk Calculator. for iMedicalApps is free.
Evidence-Based Medicine
The ACC DAPT Risk Calculator takes current ACC guidelines and combines them with cutting edge clinical data from the DAPT study to assist providers in managing patients on DAPT. It provides an evidence-based DAPT calculator for evaluating longer antiplatelet therapy at the point of care. The calculator and its evidence-based outcome data are provided in an easy to use format that is well referenced.
Who Benefits from the ACC DAPT App?
Any provider who prescribes or manages patients on anti-platelet agents including students, residents, mid-level providers, family medicine, internal medicine, emergency medicine, cardiology, anti-coagulation clinic personnel.
ACC DAPT App Pros and Cons
- Easy-to-use, intuitive interface for data input
- Evidence-based outcome data with graphic representation
- Extensive additional resources linked within the app
- Available for Android and iOS platforms
- Outcome data generated by app doesn't include NNT/number needed to harm (NNH)
- Additional resources all Internet based; nothing local in app
- Minimal instructions on the use of app or explanation of results of calculations
Overall, the ACC DAPT Risk Calculator is a must-have medical app to assist in the management of patients who may require DAPT after stent placement. The app is similar to its counterpart, the Anticoag Evaluator app, in that it includes evidence-based outcome data, but it lacks some of the finer evidence-based medicine data points such as NNT/NNH.
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.Disclosures
The views expressed are those of the author(s) and do not reflect the official policy of the U.S. Army, the U.S. Department of Defense or the U.S. government.