JCS 2020 Guideline Focused Update on Antithrombotic Therapy in Patients With Coronary Artery Disease

CConsensus from expert opinion and/or small clinical trials (including retrospective studies and case series).Scoring systems for making a comprehensive judgment on DAPT duration have been developed outside Japan.The PRECISE-DAPT score seeks to predict the bleeding risk during DAPT, and is calculated before PCI from age, history of bleeding, white blood cell count, hemoglobin, and creatinine clearance (Ccr).5 The DAPT score, the classical version prior to PRECISE-DAPT, is intended for use during the chronic phase of therapy at 1 year post-PCI and is increased with smoking, diabetes mellitus, prior myocardial infarction, prior PCI, paclitaxel-eluting stent implantation, stent diameter <3 mm, heart failure or left ventricular ejection fraction (LVEF) <30%, and vein graft stent, whereas higher age decreases the score.The DAPT score simultaneously estimates both bleeding and thrombotic risk.Studies have shown that, in patients with higher DAPT scores, continued use of DAPT reduced death and cardiovascular events, including myocardial infarction and stroke, without increasing bleeding events (Table 3).11,15,17 The DAPT score has also been reported to be applicable to Japanese patients.18 Of note, in the DAPT study that serves as the basis for calculating this score, patients who had bleeding events within the first year after PCI were excluded, and therefore this score is applicable only to low-risk patients who tolerated DAPT for 1 year after PCI.Prediction of risks for bleeding and thrombotic events immediately after PCI is more important than at ≥1 year after PCI, but enough evidence has not yet been obtained regarding this period.Therefore, care should be taken in applying those scoring systems developed outside Japan to Japanese clinical practice.In addition to the DAPT and PRECISE-DAPT scores, there are various bleeding risk scoring systems from the PARIS Registry, 19 ADAPT-DES study, 20 HORIZON AMI study, 21 CRUSADE study, 22 etc.The PARIS score derived from the PARIS Registry includes scores of not only bleeding risk but also thrombotic risk (Table 4).The common independent predictors of bleeding risk in those studies included chronic kidney disease (CKD), peripheral vascular disease, heart failure, and use of anticoagulants (or atrial fibrillation [AF]).