Abstract
Abstract Background: The SAMe-TT2R2 score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy. Objective: The aim of this study was to evaluate this score in venous thromboembolism (VTE) patients. Patients and methods: A retrospective cohort study of patients receiving care at the outpatient anticoagulation clinic of a tertiary care teaching hospital. Patients were classified as having low (score 0-1) or high risk (score ≥ 2) of not achieving a good TTR. The area under the ROC curve was calculated to assess the ability of the score to predict a TTR ≥ 65%. Adverse event-free survival curves according to the SAMe-TT2R2 score were calculated by the Kaplan-Meier method and compared by the log-rank test. A p-value < 0.05 was considered statistically significant. Results: We investigated 111 patients during a median follow-up of 2.3 (0.7-6.4) years. Mean age was 54.1 ± 15.7 years and 71 (64.0%) were women. Low- and high-risk groups had similar mean TTR (51.9 vs. 49.6%; p = 0.593). The two groups did not differ significantly in the percentage of patients achieving a TTR ≥ 65% (35.6 vs. 25.8%; p = 0.370). The c-statistic was 0.595 (p = 0.113) for TTR ≥ 65%. Adverse event-free survival during anticoagulation was also similar in both groups (p = 0.136). Conclusions: The SAMe-TT2R2 score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting.
Highlights
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are clinical manifestations of the same pathological process, collectively termed venous thromboembolism (VTE), which is the third most common cardiovascular condition after myocardial infarction and stroke, with an estimated incidence rate of 0.7-2.0 per 1,000 person-years.[1]
Patients with current cancer were initially treated with heparin and switched to vitamin K antagonists (VKA) after being in the therapeutic range
High-risk patients had higher VTE recurrence rates and bleeding (7.9 vs. 4.5/100 patient-years; p = 0.002).[8]. These results demonstrate a modest agreement between the SAMe-TT2R2 score and therapeutic range (TTR), and only studies with large samples (n > 1,000 patients) were able to detect this association
Summary
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are clinical manifestations of the same pathological process, collectively termed venous thromboembolism (VTE), which is the third most common cardiovascular condition after myocardial infarction and stroke, with an estimated incidence rate of 0.7-2.0 per 1,000 person-years.[1]. The SAMe-TT2R2 score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy. Patients were classified as having low (score 0-1) or high risk (score ≥ 2) of not achieving a good TTR. Adverse event-free survival curves according to the SAMe-TT2R2 score were calculated by the Kaplan-Meier method and compared by the log-rank test. Low- and high-risk groups had similar mean TTR (51.9 vs 49.6%; p = 0.593). Conclusions: The SAMe-TT2R2 score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting. Conclusions: The SAMe-TT2R2 score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting. (Int J Cardiovasc Sci. 2018;31(5)483-491) Keywords: Venous thrombosis; Venous thromboembolism; Pulmonary embolism; Anticoagulants; Decision support techniques
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