OBJECTIVE: This study aimed to evaluate whether a PRECISE-DAPT score ≥ 25 identifies a high-risk phenotype associated with adverse ischemic and bleeding outcomes, hospitalisation, and mortality among patients treated with fixed-dose acetylsalicylic acid and clopidogrel. METHODS: We conducted a prespecified subgroup analysis of the DAPT-TR registry, a prospective, multicentre observational cohort including 1,500 patients who were initiated on fixed-dose combination dual antiplatelet therapy (aspirin 75 mg/day plus clopidogrel 75 mg/day) for the treatment of acute and stable coronary artery disease. Patients were stratified according to PRECISE-DAPT score categories (≥ 25 vs < 25). Six-month clinical outcomes, including all-cause and cardiovascular hospitalisation, myocardial infarction, stent thrombosis, BARC type 1 bleeding, all-cause mortality, cardiovascular mortality, and stroke, were compared between groups. Multivariable logistic regression analysis was performed to evaluate independent associations between PRECISE-DAPT score categories and clinical outcomes. RESULTS: Of 1,500 patients, 344 (22.9%) had a PRECISE-DAPT score ≥ 25. Compared with patients with a PRECISE-DAPT score < 25, those with a PRECISE-DAPT score ≥ 25 were older (mean age 71.9 vs. 60.8 years; p < 0.001), more frequently female, and had significantly more comorbidities and reduced LVEF. At 6 months, patients with a PRECISE-DAPT score ≥ 25 experienced higher rates of all-cause hospitalisation (19.5% vs. 10.9%; p < 0.001), cardiovascular hospitalisation (11.6% vs. 6.7%; p = 0.003), stent thrombosis (2.6% vs. 1.0%; p = 0.029), and BARC type 1 bleeding (7.5% vs. 2.2%; p < 0.001). All-cause mortality (1.7% vs. 0.2%; p = 0.003) and cardiovascular mortality (1.2% vs. 0.1%; p = 0.011) were also significantly higher. After adjustment, a PRECISE-DAPT score ≥ 25 remained independently associated with mortality (OR: 3.8; 95% CI: 1.2-12.1) and hospitalisation (OR: 2.1; 95% CI: 1.5-3.1). CONCLUSION: A PRECISE-DAPT score ≥ 25 delineates a clinically vulnerable subgroup with elevated ischemic, haemorrhagic, and mortality risks, even under uniform fixed-dose DAPT. These findings suggest that the PRECISE-DAPT score may serve as a multidimensional prognostic tool beyond bleeding risk stratification.