Provision of DAPT Score to Cardiologists and Extension of DAPT Beyond One Year After ACS: Randomized Sub-study of the Prospective Canadian ACS Reflective II Study

Abstract Background Extension of dual antiplatelet therapy (DAPT) beyond one year after acute coronary syndrome is associated with a reduction in ischemic events, but also increased bleeding. The DAPT score identifies individuals likely to derive overall benefit or harm from DAPT extension. We sought to evaluate the impact of providing the DAPT score to treating physicians on the decision to extend DAPT beyond one year following non-ST-segment elevation myocardial infarction (NSTEMI). Methods Moderate to high-risk NSTEMI patients were enrolled from 7/2016-5/2018 in 13 Canadian hospitals by 52 cardiologists. Participating cardiologists were randomized 1:1 to receive their individual patients DAPT score prior to the 1-year follow-up visit versus not receiving their patients DAPT score. Rates of DAPT extension were compared among the randomized groups. Results At 1-year, 370 of the 585 (63.2%) patients discharged on DAPT were receiving DAPT. Among patients on DAPT at 1 year, the median (25th, 75th percentile) DAPT score was 2 (1, 3). DAPT was extended beyond 1 year in 36.2% randomized to provision of DAPT score vs. 35.7% in the control group (p=0.93). In the subgroup of patients with DAPT score ≥2, DAPT extension was 49.5% in the DAPT score provision arm vs. 40.4% in the control arm (p=0.22); among patients with DAPT score Conclusions In this exploratory randomized trial, provision of the DAPT score to treating physicians had no impact on the duration of DAPT treatment beyond one year.