HOST-EXAM Bleeding vs Ischemic Risk Index

How this tool works — clinical & methodological notes This page computes the DAPT score exactly as published by Yeh et al. (points assigned per original paper) to estimate ischemic vs bleeding trade-offs for continuing dual antiplatelet therapy after 12 months. The DAPT score ranges roughly from −2 to +10; a score ≥2 suggests potential ischemic benefit from prolonged DAPT (but this must be balanced with bleeding risk). For bleeding risk we reference the PRECISE-DAPT model (Costa et al., Lancet 2017).

The original PRECISE-DAPT is a 5-item nomogram (age, creatinine clearance, hemoglobin, white blood cell count, and prior spontaneous bleeding) that returns a numeric score; patients with PRECISE-DAPT ≥25 were classified as high bleeding risk in the derivation and validation cohorts. Because the original nomogram assigns continuous points via the published figure, this template uses a conservative, explicit proxy rule (prior bleeding OR age ≥75 OR hemoglobin <11 g/dL OR CrCl <50 mL/min OR WBC >12 if available) to flag patients who very likely fall into the high PRECISE-DAPT stratum; this proxy is intentionally conservative and transparent — it is meant to be clinically safe and to flag patients for specialist review or for calculation with the official PRECISE-DAPT tool when needed. For exact numeric PRECISE-DAPT use the original nomogram or the validated web calculator.

Limitations This implementation: - provides an exact DAPT score per the original study but a conservative PRECISE-DAPT proxy rather than reproducing the nomogram's exact 0–100 numeric mapping; the proxy increases sensitivity for bleeding signals (intentionally conservative) and is NOT a substitute for the original PRECISE-DAPT nomogram when precise numeric probability is required. - does not replace clinical judgement — scores are decision aids only and must be interpreted in clinical context (anticoagulation, active cancer, frailty, recent procedures, frailty, and patient values all influence decisions). References Costa F, van Klaveren D, James S, et al. Derivation and validation of the PRECISE-DAPT score: a pooled analysis of individual-patient datasets from clinical trials.

Lancet. 2017;389:1025–1034. (PRECISE-DAPT nomogram and high-risk cutoff ≥25). Yeh RW, Secemsky EA, Kereiakes DJ, et al.

Development and Validation of the DAPT Score. JAMA. 2016;315(16):1735–1749. (DAPT score point assignments and interpretation).

Official PRECISE-DAPT web calculator (nomogram / app): PRECISE-DAPT website. (Use this for the exact numeric PRECISE-DAPT score).