Since the development of the first bare metal (BMS) and drug eluting stents (DES), the literature and guidelines have been debating about how and how long to continue anti-platelet therapy. 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 mos 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 and cerebrovascular, but a greater risk of moderate to severe bleeding. In 2016, the DAPT Study was published in JAMA 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 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. The content of the ACC DAPT Risk Calculator is based on the DAPT calculator published in JAMA in 2016. 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 past medical history of hypertension, Type II 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 out to 30 months? What if the patient was 75 years old?

Video Review of ACC DAPT Risk Calculator Medical App

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Evidence based medicine

ACC DAPT Risk Calculator takes current ACC guidelines and combines them with cutting edge clinical trial data from the DAPT trial 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.

What providers would benefit from the ACC DAPT Risk Calculator Medical App?

Students, residents, mid-levels, Family Medicine, Internal Medicine, Emergency Medicine, Cardiology, anti-coagulation clinic personnel. Any provider who prescribes or manages patients on anti-platelet agents.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

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