Relation of the SAMe-TT2R2 score to quality of anticoagulation control and thromboembolic events in atrial fibrillation patients: Observations from the SPORTIF trials.

Background Oral anticoagulant therapy is central to the prevention thromboembolic events in atrial fibrillation (AF) patients. The SAMe-TT 2 R 2 score is a simple clinical-derived score designed to aid decision-making on whether or not a patient is likely to achieve good anticoagulation control on vitamin K Antagonists (VKA, e.g. warfarin). Good anticoagulation control is associated with optimal VKA efficacy and safety. Methods The SAMe-TT 2 R 2 score was studied in a large cohort of warfarin-treated non-valvular AF patients from the SPORTIF trials, and related to time in therapeutic range (TTR) as measure of anticoagulation control, and thromboembolism-related outcomes. Results Among the 3665 patients originally assigned to the warfarin arm, a SAMe-TT 2 R 2 score > 2 was found in 19.5%. In these patients, a linear relationship was reported between SAMe-TT 2 R 2 score and TTR (p < 0.001). SAMe-TT 2 R 2 > 2 was inversely associated with a higher proportion with TTR > 65% (p = 0.014) or TTR > 70% (p = 0.011). Patients with SAMe-TT 2 R 2 score > 2 had a significantly higher event rate of the composite thromboembolism-related outcome, vs. SAMe-TT 2 R 2 0–2 (10.2% vs. 7.9%, p = 0.045). On survival analysis, SAMe-TT 2 R 2 > 2 was associated with a higher risk for the composite outcome (Log-Rank: 5.471, p = 0.019). On Cox regression, a SAMe-TT 2 R 2 score > 2 was independently associated with the composite outcome (p = 0.020). Conclusions In this large trial cohort of AF patients, the SAMe-TT 2 R 2 score was able to identify patients more likely to obtain suboptimal anticoagulation control on VKA, with an increase in major thromboembolism-related adverse events consequent upon such poor anticoagulation control. [ABSTRACT FROM AUTHOR]