Key result
The VKORC1 1173C > T genotype was associated with a higher time in therapeutic range than the VKORC1 TT genotype (61.7% vs 56.7%), while the SAMe-TT2R2 score showed no association with INR control.
Why the study?
Does the SAMe-TT2R2 score or CYP2C9/VKORC1 genotype predict the quality of anticoagulation control in Korean patients with atrial fibrillation on warfarin?
Cohort (n=380)
No
Does the SAMe-TT2R2 score or CYP2C9/VKORC1 genotype predict the quality of anticoagulation control in Korean patients with atrial fibrillation on warfarin?
Absolute Event Rate: 61.7% vs 56.7%
p-value: p=0.031
In Korean patients with atrial fibrillation, the VKORC1 genotype, but not the clinical SAMe-TT2R2 score, was significantly associated with the quality of anticoagulation control on warfarin.
SAMe-TT2R2 score shows no link to CYP2C9/VKORC1 variants or TTR; leaves open its utility for guiding anticoagulation choice in AF.
BACKGROUND AND PURPOSE: Advantages of new oral anticoagulations may be greater in atrial fibrillation (AF) patients of poor anticoagulation control with warfarin. The SAMe-TT2R2 scoring system, based on clinical variables, was recently developed to aid in identifying these patients. In this study, we investigated the association of this clinical composite score with genetic factors related warfarin dosing and the quality of anticoagulation control. METHODS: Clinical and genetic data were collected from 380 consecutive Korean patients with AF (CHA2DS2-VASc score, 3.5±1.8) who were followed for an average of 4 years. We evaluated factors associated with time in therapeutic range (TTR, INR 2-3), including the CYP2C9 and VKORC1 genotypes and the SAMe-TT2R2 score (Sex female, Age <60 years, Medical history [>two co-morbidities], Treatment [interacting drugs, e.g., amiodarone], Tobacco use within 2 years [doubled], and Race non-white [doubled]). RESULTS: The average SAMe-TT2R2 score was 3.4±0.9, range 2-7; and 153 patients (40.2%) had SAMe-TT2R2 scores ≥4. Time in specific INR ranges varied depending on the VKORC1 genotype but not with the CYP2C9 genotype or the SAMe-TT2R2 score. TTR was higher in patients with the VKORC1 1173C>T than in VKORC1 TT (61.7±16% vs. 56.7±17.4%, P=0.031). Multivariate testing showed that VKORC1 genotype but not the SAMe-TT2R2 score was significantly associated with labile INRs. There was no correlation between the SAMe-TT2R2 scores and pharmacogenetic data. CONCLUSIONS: A genetic factor, but none of the common clinical and demographic factors, as combined in the SAMe-TT2R2 score, was associated with the quality of anticoagulation control in Korean patients with AF.
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Park et al. (2015) conducted a cohort in Non-valvular atrial fibrillation (n=380). VKORC1 1173C > T genotype vs. VKORC1 TT genotype was evaluated on Time in therapeutic range (TTR, INR 2-3) (p=0.031). The VKORC1 1173C > T genotype was associated with a higher time in therapeutic range than the VKORC1 TT genotype (61.7% vs 56.7%), while the SAMe-TT2R2 score showed no association with INR control.
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