Key result
The SAMe-TT2R2 score was significantly associated with the composite outcome of major bleeding, thromboembolic complications, and death (HR 1.32; 95% CI 1.08-1.60; P=0.03).
Why the study?
Does the SAMe-TT2R2 score predict the quality of anticoagulation control and clinical outcomes in patients with non-valvular atrial fibrillation on vitamin-K antagonists?
Cohort (n=911)
Does the SAMe-TT2R2 score predict the quality of anticoagulation control and clinical outcomes in patients with non-valvular atrial fibrillation on vitamin-K antagonists?
Hazard Ratio: 1.32 (95% CI 1.08–1.6)
p-value: p=0.03
The SAMe-TT2R2 score is a useful clinical tool to identify NVAF patients likely to have poor anticoagulation control on VKAs and predicts the composite outcome of major bleeding, thromboembolism, and death.
SAMe-TT2R2 may help flag NVAF patients prone to poor VKA control; leaves open prospective validation before routine use.
AIMS: Clinicians need to get better at identifying patients who would have poor quality of anticoagulation control with vitamin-K antagonists (VKAs). We assessed the predictive ability of SAMe-TT2R2 score, recently conceived for the prior purpose, and examined its relationship with major bleeding, thromboembolic (TE) complications, and death. METHODS AND RESULTS: Retrospectively, 911 consecutive patients with non-valvular atrial fibrillation (NVAF) started on VKAs within 8 months were studied. The percentage of international normalized ratios in therapeutic range (PINRR) at different levels was used as a metric of anticoagulation quality. We also tested the SAMe-TT2R2 predictability for major bleeding, TE complications, and death throughout 10 ± 3 months. The PINRR decreased from 62% at zero point to 53% at ≥4 points of SAMe-TT2R2. 82.1% of patients who achieved PINRR ≥ 70% had 0 or 1 point of SAMe-TT2R2. SAMe-TT2R2 performed significantly better at PINRR 70% than at 65 and 60% (c-statistic = 0.60 vs. c-statistic = 0.56). The calibration of SAMe-TT2R2 was excellent (Hosmer-Lemeshow test P-values ≥ 0.6). SAMe-TT2R2 showed significant association with the composite outcome of major bleeding, TE complications, and death [n = 98; hazard ratio (HR) = 1.32; 95% confidence interval (CI) 1.08-1.60]; the c-statistic was 0.57 (95% CI: 0.51-0.62) and P = 0.03. As individual outcomes, SAMe-TT2R2 was significantly associated with death (n = 60; HR = 1.3; 95% CI: 1.03-1.69), but not with either major bleeding (n = 30; HR = 1.2; 95% CI: 0.85-1.76) or TE complications (n = 15; HR = 1.01; 95% CI: 0.58-1.77). CONCLUSION: Among NVAF patients, SAMe-TT2R2 could represent a useful clinical tool to identify patients who would have poor quality of anticoagulation control with VKAs. SAMe-TT2R2 successfully predicts the composite outcome of major bleeding, TE complications, and death.
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Abumuaileq et al. (2015) conducted a cohort in non-valvular atrial fibrillation (n=911). SAMe-TT2R2 score was evaluated on composite outcome of major bleeding, TE complications, and death (HR 1.32, 95% CI 1.08-1.60, p=0.03). The SAMe-TT2R2 score was significantly associated with the composite outcome of major bleeding, thromboembolic complications, and death (HR 1.32; 95% CI 1.08-1.60; P=0.03).
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