2026 Southeastern Residency Conference

Evaluation of the PRECISE-DAPT Score in Predicting CABG Related Bleeding Readmissions
Inyeong Choi, Danielle McPherson, Davide Ventura
AdventHealth Orlando, FL

Background/Purpose: Dual antiplatelet therapy (DAPT) is recommended for patients after coronary artery bypass graft surgery (CABG) with concomitant acute coronary syndrome (ACS) or recent history of percutaneous coronary intervention (PCI). Large scale analyses have confirmed the external validity of the PRECISE-DAPT score demonstrating that high risk patients (score ≥ 25) have a 3- to 4-fold increased risk of major bleeding. The PRECISE-DAPT score is a five-item bleeding risk score validated in the PCI patient population to assist clinician’s informed decision making on duration of DAPT. This score is determined by age, creatinine clearance (CrCl), white blood cell (WBC) count, hemoglobin (Hgb), and history of bleeding at baseline. However, no validated bleeding risk scores exist for the CABG population. Recently, Society of Thoracic Surgeons (STS) registry data at AdventHealth noted a high rate of re-admissions due to bleeding complications. The benefit of DAPT after CABG remains uncertain as recent trials show no clear ischemic advantage at the expense of more bleeding. This study aims to evaluate the association of the PRECISE-DAPT score and bleeding readmissions in patients discharged from DAPT after CABG.

Methodology: This study was a retrospective cohort study conducted from August 2022 to August 2025. This study included patients who were re-admitted after CABG at AdventHealth Orlando and Celebration campuses due to bleeding complications within 90 days. Bleeding complications included gastrointestinal bleeding (GIB), anticoagulation complications , pleural or pericardial effusion requiring intervention, or hemorrhagic stroke. The PRECISE-DAPT score was retrospectively calculated based on age, CrCl, WBC, Hgb, and history of bleeding. The primary outcome was to evaluate the association of the PRECISE-DAPT score and re-admissions due to bleeding complications. The secondary outcomes included bleeding events defined by the Bleeding Academic Research Consortium (BARC) criteria, time to re-admission, transfusion requirements, and any changes to antiplatelet or anticoagulant regimens. Categorical data were analyzed via a Chi-square test or Fischer’s Exact test. Continuous data were analyzed via a Mann-Whitney U test or Kruskal-Wallist test.

Results: A total of 95 patients with CABG with or without valve replacements were included in the final analysis. Twenty-five patients had a PRECISE-DAPT score < 25 (low bleeding risk) and 70 patients had a PRECISE-DAPT score ≥ 25 (high bleeding risk). The high-risk group had an average score of 43 and accounted for 74% of all bleeding complications. Additionally, high-risk patients experienced numerically more clinically relevant bleeding events (BARC type 2 or greater) than the low-risk group (28 vs. 8, p = 0.342). After readmission, 53% of DAPT patients in the high-risk group were transitioned to single antiplatelet therapy (SAPT) compared with 23% in the low-risk group. Transfusion requirements were comparable between the two groups, with 22.9% in the high-risk group and 28% in the low-risk group.

Conclusion: Elevated PRECISE-DAPT scores are associated with increased risk. Though currently validated for PCI patients only, the PRECISE-DAPT score offers a viable tool for risk stratification in CABG patients. Incorporating the PRECISE-DAPT score in surgical patients may inform tailored antithrombotic regimens as a strategy to minimize bleeding readmissions.