Validation of the SAMe-TT2R2 score in a nationwide population of nonvalvular atrial fibrillation patients on vitamin K antagonists

How to identifying patients who are going to do well on Vitamin K Antagonists: Guesswork or use the SAMe-TT2R2 score?

When using the Vitamin K Antagonists (VKAs) it’s not simply writing a prescription and forgetting about it.  Attention is needed to the quality of anticoagulation control, as reflected by time in therapeutic range (TTR).  Many common clinical features have been associated with a poor TTR.  With incorporation of these features into a reliable risk score, patients prone to be poorly controlled anticoagulation with the VKAs might be identified. Such a tool, predicting which patient is going to do well on the VKAs might be the SAMe-TT2R2 score, considering various common clinical variables such as sex, age, medical history, treatment, tobacco use, and race.   This would be better than guess work, or a ‘trial of VKA’ to see if a good TTR can be achieved (and putting patients at risk of thrombosis during the period of poor TTR).

After validating the SAMe-TT2R2 score in a prospective multicenter nationwide cohort of patients with atrial fibrillation, Dr. Ruiz Ortiz, Cardiology Specialist at the Echocardiography Unit, Cardiology Department, Reina Sofía University Hospital, Córdoba, Spain, concluded that the score is moderately able to identify patients with good anticoagulation control in a nationwide sample of patients with nonvalvular atrial fibrillation on treatment with vitamin K antagonists. He emphasized that the population was recruited in outpatient cardiology clinics all over his country and that all results were consistent.

The findings are clinically significant, he said: "I think that the strategy of choosing VKAs for people with a high probability of doing well on these drugs, as assessed by the SAMe-TT2R2 score, and reserving the non-VKA oral anticoagulants (NOACs) for the rest of the patients is very attractive. I must recognize that this approach has not yet been prospectively assessed in a properly designed randomised trial, so we should await more data."

According to Ruiz, the main implication of his findings for medical professionals is that the SAMe-TT2R2 scores provides an easy and useful way of assessing one patient’s chance of doing well on the VKAs. Those who are unlikely to do well can be flagged up for more regular review or educational measures; otherwise a NOAC can be used.    

Werner Zwick, M.A., Munich, Germany

Martín Ruiz-Ortiz M et al.: Opens external link in new windowValidation of the SAMe-TT2R2 score in a nationwide population of nonvalvular atrial fibrillation patients on vitamin K antagonists. Thromb Haemost 2015 114 4: 695-701

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