It is not a substitute for clinical judgment. The DAPT Score should be used to guide antiplatelet duration in conjunction with clinical judgment and applied on an individualized basis. What recommendations do you have for doctors once they have applied the DAPT Score? Are there any adjustments or updates you would make to the score based on new data or practice changes? In addition, the score was derived in patients who were not taking long term oral anticoagulants like Coumadin and had no history of major bleeding in the past. However, although this is high quality evidence that has made its way into national guidelines, the DAPT Score is meant to be used in conjunction with clinical judgment. The data are based on the largest ever randomized blinded trial of antiplatelet therapy that we led at the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute). The DAPT Score gives clinicians an opportunity to see how patients with particular characteristics fared when randomized to either 30 months or 12 months of dual antiplatelet therapy after receiving a stent. What pearls, pitfalls and/or tips do you have for users of the DAPT Score? Do you know of cases when it has been applied, interpreted, or used inappropriately? We wanted to develop a tool that could help clinicians identify who were the best patients to continue long term antiplatelet medications after heart stents, and who were the patients best served by shorter durations of these medications. On the other hand, the drugs can also lead to bleeding. On one hand, continuing these medications can prevent heart attacks. The question of how long to continue antiplatelet therapy after coronary stent procedures has troubled physicians for many years. Therefore, the TIMI risk score should not be used in isolation to determine disposition of ED chest pain patients.Why did you develop the DAPT Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians? Also, patients with the lowest risk as defined by a TIMI score of zero had a 1.7% incidence of adverse events. However, in our study the TIMI risk score failed to stratify these patients into discrete groups according to risk score. This relationship was highly significant.Īmong ED patients with chest pain, the TIMI risk score does correlate with outcome. The incidence of each TIMI risk factor was age greater than 65 years 21%, known coronary stenosis 18%, 3 or more risk factors 26%, ST-segment deviation 6%, 2 or more anginal events in the previous 24 hours 33%, aspirin use in the previous 7 days 35%, and elevated markers 6%. Myocardial infarction occurred in 95 patients. Patients had mean age of 53.2+/-14 years and were 40% men, 66% black, and 30% white. There were 1,481 eligible patient visits 30-day follow-up was completed on 1,458 (98.4%) patients. The main outcome was death, acute myocardial infarction, or revascularization as stratified by TIMI risk score at 30 days. Investigators followed the hospital course daily for admitted patients, and 30-day follow-up was performed on hospitalized and discharged patients. Data included demographics, medical and cardiac history, and components of the TIMI risk score. This was a prospective observational cohort study of consecutive ED chest pain patients enrolled from July 2003 until October 2004. To validate the use of the TIMI risk score in the ED, we prospectively assess its potential utility in a broad ED chest pain patient population. It has been retrospectively evaluated in emergency department (ED) patients with potential acute coronary syndrome but has not been prospectively validated in this patient population. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a 7-item tool derived from trials of patients with unstable angina/non-ST segment elevation myocardial infarction for risk stratification with respect to outcomes.
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