Key result
The SAMe-TT2R2 and SAMe-TT2G2 scores showed poor discrimination for predicting inadequate anticoagulation control (c-index < 0.60) in Chinese patients with non-valvular atrial fibrillation.
Why the study?
The study was conducted to validate the SAMe-TT2R2 and SAMe-TT2G2 scores in Chinese patients with non-valvular atrial fibrillation treated with warfarin and evaluate factors associated with time in therapeutic range.
Do the SAMe-TT2R2 and SAMe-TT2G2 scores predict inadequate anticoagulation control (TTR < 65.0%) in Chinese patients with NVAF on warfarin?
Cohort (n=379)
Yes
Do the SAMe-TT2R2 and SAMe-TT2G2 scores predict inadequate anticoagulation control (TTR < 65.0%) in Chinese patients with NVAF on warfarin?
Effect estimate: c-index < 0.60
The SAMe-TT2R2 and SAMe-TT2G2 scores have poor discrimination for predicting inadequate anticoagulation control in Chinese patients with NVAF on warfarin.
These scores should not guide VKA decisions in Chinese NVAF patients; leaves open development of ethnicity-specific predictors.
Objective The sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) Score; the sex, age, medical history, treatment, tobacco use, genotype combination (SAMe-TT2G2) Score; and the so-called modified SAMe-TT2R2 scores have been proposed to predict the anticoagulation quality for patients with non-valvular atrial fibrillation (NVAF). The data from a prospective controlled study is used to validate the SAMe-TT2R2 and SAMe-TT2G2 scores in Chinese NVAF patients treated with warfarin and to evaluate the association of factors with time in therapeutic range (TTR) to predict the quality of oral anticoagulation control.Methods A total of 379 patients with NVAF under warfarin treatment for a three-month follow-up were included in this prospective, multicenter study. The quality of oral anticoagulation control was evaluated by the TTR. The TTR was dichotomized for binary logistic regression analysis, using a cutoff point for classification as an inadequate (TTR < 65.0%) control.Results The 379 NVAF patients had a mean TTR of 58.35 ± 26.33% and median SAMe-TT2R2 and SAMe-TT2G2 scores of 3 and 2, respectively. The discrimination performances of the SAMe-TT2R2 and SAMe-TT2G2 scores for inadequate anticoagulation control (TTR < 65.0%) were poor (c-index < 0.60). The gene frequency of CYP2C9*3 was 3.2% and that of VKORC1-1639 G > A was 89.3%. Genetic variation of CYP2C9*3 and VKORC1-1639 G > A did not affect TTR after initial treatment. The condition TTR < 65.0% was associated with an age below 60 without genotype-guided warfarin dose initiation and concomitant torasemide.Conclusions A warfarin-dosing algorithm used for initial treatment of patients older than 60 helps to achieve a better quality of oral anticoagulation control, whereas concomitant torasemide can produce a negative effect. These findings provide useful information for future investigations on the quality of oral anticoagulation control in Chinese anticoagulation clinical practice.
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Li et al. (2020) conducted a cohort in Non-valvular atrial fibrillation (NVAF) (n=379). SAMe-TT2R2 and SAMe-TT2G2 scores was evaluated on Inadequate anticoagulation control (Time in Therapeutic Range < 65.0%) (c-index < 0.60). The SAMe-TT2R2 and SAMe-TT2G2 scores showed poor discrimination for predicting inadequate anticoagulation control (c-index < 0.60) in Chinese patients with non-valvular atrial fibrillation.
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