π« DAPT Score Calculator
After PCI: does prolonged dual antiplatelet therapy help you?
Educational only. DAPT duration decisions belong to your cardiologist.
After a coronary stent, two antiplatelet drugs (usually aspirin plus clopidogrel or ticagrelor) prevent clots, but they also cause bleeding. The DAPT score, derived from the Dual Antiplatelet Therapy trial, weighs your ischemic risk against bleeding risk to guide duration: 12 months standard, or 30 months prolonged. Score -2 to 10; 2 and above favors longer therapy. Check your factors above.
How to Use This Calculator
Select age and check the clinical and procedural factors. The score and duration guidance appear.
Choose the age band. Older age subtracts points because bleeding risk rises with age.
Check each factor: diabetes, MI presentation, prior PCI/MI, small stent, smoking, paclitaxel stent, heart failure, vein graft stent.
Read the guidance: 2+ favors 30 months, below 2 favors 12 months. Your cardiologist confirms with bleeding assessment.
The Score Components
Yeh and colleagues derived the score from nearly 12,000 DAPT trial patients who had completed 12 uneventful months of therapy. The factors that predicted ischemic events (stent thrombosis, MI) without predicting bleeding earned positive points; age, which predicts bleeding more than ischemia, earned negative points. The elegance is the subtraction: the score is not an ischemia score but a net-benefit score, which is why older patients with multiple stents can still land below 2.
The trial's headline: 30 months of DAPT cut stent thrombosis and major cardiovascular events versus 12 months, at the cost of more moderate-severe bleeding and a debated mortality signal. The score personalizes that tradeoff. High scorers get more ischemic protection than bleeding harm; low scorers get more bleeding than benefit. It applies at the 12-month decision point in patients who tolerated the first year without events.
Worked Example
A 58-year-old smoker with diabetes, MI at presentation, and a 2.5 mm stent: age 0 + diabetes 1 + MI 1 + smoker 1 + small stent 1 = 4. Prolonged DAPT favored: this patient's ischemic risk clearly outweighs bleeding. Contrast a 78-year-old with a single large stent and no other factors: age -2, total -2. Standard 12 months: extending therapy would mostly add bleeding. The age subtraction does real work here, which is the score's most underappreciated feature.
Bleeding Risk: The Other Half
DAPT score handles net benefit, but dedicated bleeding tools refine it: PRECISE-DAPT (hemoglobin, white cells, age, creatinine clearance, prior bleeding) predicts out-of-hospital bleeding on DAPT, and high bleeding risk can shorten therapy to 6 or even 3 months with newer stents, or prompt de-escalation strategies (dropping aspirin, keeping the P2Y12 inhibitor). ARC-HBR criteria define high bleeding risk formally. The modern trend is shorter DAPT for high-bleeding-risk patients and guided de-escalation, so the 12-vs-30 framing is the starting point, not the whole menu.
Never stop DAPT early without cardiology input: premature discontinuation is the leading cause of stent thrombosis, which carries high mortality. If surgery or bleeding forces a stop, the cardiologist balances the risks with bridging strategies. And the score assumes 12 uneventful months already completed; it does not guide the initial duration decision right after stenting, which follows different (usually 12-month default, shorter if bleeding risk demands) logic.
What Patients Should Know
Take both drugs exactly as prescribed: the protection only works with adherence, and the bleeding risk is the price. Report unusual bruising, nosebleeds, blood in urine or stool, or black stools promptly. NSAIDs and alcohol amplify bleeding; tell every doctor and dentist you are on DAPT before procedures. The 12-month mark is a decision point, not an autopilot refill: ask your cardiologist for your DAPT score and the plan. Knowing the number turns a passive prescription into a shared decision.
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For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the DAPT score?
A -2 to 10 score predicting net benefit of prolonged dual antiplatelet therapy after coronary stenting, derived from the DAPT trial (Yeh et al.). Scores >= 2 favor 30 months of DAPT; below 2 favor 12 months. It balances ischemic benefit against bleeding risk.
How long should DAPT continue after a stent?
Standard is 12 months; the DAPT score guides extension to 30 months for scores >= 2. High bleeding risk may shorten to 6 or 3 months with newer stents. Your cardiologist individualizes it; never stop early without cardiology input.
What does a DAPT score of 2 mean?
The cutoff: 2 or higher favors prolonged (30-month) dual antiplatelet therapy because ischemic benefit outweighs bleeding risk. Below 2 favors the standard 12 months. It is a net-benefit threshold, not a risk grade.
Why does older age subtract DAPT points?
Because age predicts bleeding more strongly than it predicts ischemic events. The score measures net benefit, so factors that add bleeding without proportional ischemic risk subtract from the total.
What are the bleeding risks of prolonged DAPT?
More moderate-to-severe bleeding, including gastrointestinal bleeding requiring transfusion or hospitalization. The DAPT trial showed this tradeoff clearly, which is why duration is individualized rather than maximized.
Can DAPT be shortened for high bleeding risk?
Yes. PRECISE-DAPT and ARC-HBR identify high bleeding risk, where 6-month, 3-month, or even 1-month DAPT with newer stents, or aspirin-free strategies, are used. Shorter is safer for bleeders; the ischemic cost is managed with modern stents.
What happens if you stop DAPT early?
Premature discontinuation sharply raises stent thrombosis risk, which causes MI or death in a large fraction of cases. If surgery or bleeding forces interruption, cardiologists use bridging strategies. Never stop on your own.
Which drugs are used in DAPT?
Aspirin plus a P2Y12 inhibitor: clopidogrel, ticagrelor, or prasugrel. Choice depends on the clinical scenario (ACS vs stable), bleeding risk, and genetics (clopidogrel needs CYP2C19 activation).
Does the DAPT score apply right after stenting?
No. It was derived for the 12-month decision point in patients who completed a year without ischemic or bleeding events. Initial duration decisions follow separate guidance.
What is PRECISE-DAPT?
A 5-item bleeding risk score (age, creatinine clearance, hemoglobin, white cell count, prior bleeding) predicting out-of-hospital bleeding on DAPT. High scores support shorter DAPT durations. It complements the DAPT score's net-benefit framing.