The SAMe-TT2R2 Score Predicts Warfarin Control in an Australian Population with Atrial Fibrillation

Abstract

Background: Warfarin requires regular monitoring with the time in therapeutic range (TTR), a common indicator of control and TTR > 70% is indicative of efficient anticoagulation. The SAMe-TT2R2 (sex, age, medical history, treatment, tobacco use, race) model has been utilised as a predictor of warfarin control, with a score ≥ 2 indicative of poor control. However, it has been suggested that race may be over-represented in this model. To date, no Australian studies have applied this model, possibly because race is not routinely recorded. Therefore, the aim of this study was to apply the SAMe-TT2R2 model in an Australian population on warfarin managed by both a warfarin care program (WCP) and general practitioner (GP). Methods: Retrospective data was collected for patients receiving warfarin via a WCP in Queensland and whilst being managed by a GP. Patient data was used to calculate the SAMe-TT2R2 score and the TTR for each patient. Mean TTR was used for analysis and comparison with the categorised SAMe-TT2R2 score. Results: Of the 3911 patients managed by a WCP, there was a significantly lower mean TTR for patients with a SAMe-TT2R2 score ≥ 2 compared to 0–1 (78.6 ± 10.7% vs. 80.9 ± 9.5%, p < 0.0001). Of these patients, 200 were analysed whilst managed by a GP and the categorised SAMe-TT2R2 score did not result in a statistically different mean TTR (69.3 ± 16.3% with 0–1 vs. 63.6 ± 15.0% with ≥2, p = 0.089), but a score ≥2 differentiated patients with a TTR less than 65%. Conclusions: The SAMe-TT2R2 model differentiated Australian patients with reduced warfarin control, despite the exclusion of race. In Australia, the SAMe-TT2R2 score could assist clinicians in identifying Australian patients who may obtain reduced warfarin control and benefit from additional interventions such as a dedicated WCP.

[Retracted] Evaluation of ABC Bleeding Score and SAMe‐TT2R2 Score on the Risk of Bleeding after Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Complicated with Coronary Heart Disease

“…Studies have shown that the higher the SAMe-TT2R2 score of patients, the greater the risk of adverse reactions [12,13]. e SAMe-TT2R2 score assignment is influenced by race, with the main studies focusing on nonwhite populations [14][15][16]. e lowest score of patients in my country is 2 points, so there will be a of high SAMe-TT2R2 score.…”

Chinese stroke patients with atrial fibrillation used Robert's age-adjusted warfarin loading protocol obtained good INR results within therapeutic range

“…Conversely, SAMeTT2R2 score ≥ 2 predicts poor INR control on warfarin and NOACs are recommended for these patients to achieve acceptable anticoagulation therapy control 16 . Though SAMeTT2R2 score has been shown to be a good predictor in the Caucasian population 16 , 30 , its predictive value is very limited in Asian populations due to the fact that non-Caucasian status is immediately assigned 2 points. It is not surprising to find non-Caucasian patients with SAMeTT2R2 score ≥ 2 but with average TTR higher than 78% 31 or those with SAMeTT2R2 score ≥ 3 but with TTR higher than 70% 32 .…”

Effect of SAMe-TT2R2 score and genetic polymorphism on the quality of anticoagulation control in Qatari patients treated with warfarin

“…However, SAMe-TT 2 R 2 overall score was associated with TTR and was the only predictor of poor quality of anticoagulation in the multivariate analysis but only when a score of one was used as a cut-off instead of two. Since SAMe-TT 2 R 2 score was proposed and validated by Apostolakis and colleagues [30], external validation studies in populations from various countries took place and results were mostly positive [35][36][37][38][39][40]. Additionally, the score was tested in deep venous thrombosis as opposed to non-valvular atrial fibrillation patients and it was also shown to have a modest predictive ability for the quality of INR control [41,42].…”