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A prospective validation of the SAME-TT2R2 score: how to identify atrial fibrillation patients who will have good anticoagulation control on warfarin

Internal and Emergency Medicine volume 9, pages 443–447 (2014)Cite this article

Abstract

Stroke prevention, achieved with oral anticoagulation therapy (OAT), is central to the management of patients with atrial fibrillation (AF). Well-managed OAT, as reflected by a long time in therapeutic range (TTR), is associated with good clinical outcomes. The SAME-TT2R2 score has been proposed to identify patients who will maintain a high average TTR on vitamin K antagonists (VKA) treatment. The objective of the study was to validate this score in a cohort of AF patients followed by an anticoagulation clinic. We applied the SAME-TT2R2 score to 1,089 patients with AF on VKAs followed by two anticoagulation clinics. The median TTR overall for the whole cohort was 73.0 %. There was a significant decline in mean (or median) TTR in relation to the SAME-TT2R2 score (p = 0.042). When the SAME-TT2R2 scores were categorized we find a TTR 74.0 % for score ≤2 and 68.0 % for score >2 (p = 0.006). The rate of major bleeding events and stroke/TIA was 1.78 × 100 patient-years (pt-yrs) and 1.26 × 100 pt-yrs, respectively. No relationship exists between the SAME-TT2R2 score and adverse events. We describe the first validation of the SAME-TT2R2 score in AF patients where, despite an overall good quality of anticoagulation, the SAME-TT2R2 score is able to identify the patients who are less likely to do well on VKA therapy if this is the chosen OAT.

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Affiliations

  1. Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, 50134, Florence, Italy

    Daniela Poli

  2. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Emilia Antonucci

  3. Haemostasis and Thrombosis Centre, A O Istituti Ospitalieri di Cremona, Cremona, Italy

    Sophie Testa

  4. Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, B18 7QH, UK

    Gregory Yoke Hong Lip

Authors
  1. Daniela Poli
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  2. Emilia Antonucci
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  3. Sophie Testa
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  4. Gregory Yoke Hong Lip
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Correspondence to Daniela Poli.

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Poli, D., Antonucci, E., Testa, S. et al. A prospective validation of the SAME-TT2R2 score: how to identify atrial fibrillation patients who will have good anticoagulation control on warfarin. Intern Emerg Med 9, 443–447 (2014). https://doi.org/10.1007/s11739-014-1065-8

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  • DOI: https://doi.org/10.1007/s11739-014-1065-8

Keywords

  • Atrial fibrillation
  • Vitamin K antagonist
  • Oral anticoagulant therapy
  • TTR