{"id":31105,"date":"2020-04-14T19:34:38","date_gmt":"2020-04-14T14:04:38","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=31105"},"modified":"2020-04-14T19:34:38","modified_gmt":"2020-04-14T14:04:38","slug":"same-tt%e2%82%82r%e2%82%82-score-for-poor-inr-control","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/same-tt%e2%82%82r%e2%82%82-score-for-poor-inr-control\/","title":{"rendered":"SAMe-TT\u2082R\u2082 score for poor INR control"},"content":{"rendered":"<h2><span style=\"color: #008000;\">SAMe-TT\u2082R\u2082 score for poor INR control<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/fPIZrvUP8DM\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><br \/>\nSAMe-TT\u2082R\u2082 score aims at predicting those likely to have poor INR (International Normalized Ratio of Prothrombin Time) control while on vitamin K antagonists [1]. The investigators divided the&nbsp;Atrial Fibrillation Follow-up Investigation of Rhythm Management (<a href=\"https:\/\/johnsonfrancis.org\/professional\/affirm-on-treatment-analysis\/\">AFFIRM<\/a>) trial cohort randomly into a derivation cohort and an internal validation cohort.<\/p>\n<p>They used linear regression analysis to find out the clinical parameters associated with time in therapeutic window (TTR) while on warfarin. Binary logistic regression analysis was used to evaluate the predictive performance of a model created using these factors. The prediction model was externally validated using a prospectively recruited cohort receiving anticoagulation.<\/p>\n<p>SAMe-TT\u2082R\u2082 score derived thus had the following parameters:<\/p>\n<p style=\"padding-left: 40px;\">Sex female<\/p>\n<p style=\"padding-left: 40px;\">Age &lt; 60 years<\/p>\n<p style=\"padding-left: 40px;\">Medical history (more than two comorbidities)<\/p>\n<p style=\"padding-left: 40px;\">Treatment (interacting drugs, eg, amiodarone for rhythm control)<\/p>\n<p style=\"padding-left: 40px;\">Tobacco use (doubled)<\/p>\n<p style=\"padding-left: 40px;\">Race (doubled)<\/p>\n<p>Those with scores of zero or 1 did well on warfarin with good TTR. In those with a score of 2 or more, additional interventions are required to achieve adequate anticoagulation. Direct oral anticoagulants (DOACs) may be considered in patients with a score of two or more.<\/p>\n<p>It is not very sure whether this score will do well in those with valvular heart disease as 95% of patients enrolled in the AFFIRM trial did not have valvular disease.<\/p>\n<p>Lip GYH et al evaluated 4,637 patients who were receiving vitamin K antagonists to see whether SAMe-TT\u2082R\u2082 score could discriminate those who were likely to have a labile INR, stroke\/thromboembolism, clinically relevant bleeding and death while on treatment [2]. They found a significant increase in risk of severe bleeding in patients with a high SAMe-TT\u2082R\u2082 score (&gt; 2).&nbsp;Increasing SAMe-TT\u2082R\u2082 score was associated with an increasing risk of labile INR, stroke\/thromboembolism, severe bleeding and death on follow-up. Mean follow-up period was 1,016 days in that study.<\/p>\n<p>Another study which retrospectively checked 911 patients with non-valvular atrial fibrillation on vitamin K antagonists also reached similar conclusions [3]. They found that SAMe-TT\u2082R\u2082 score is a clinical tool useful to identify patients who have poor quality of anticoagulation control. SAMe-TT\u2082R\u2082 score successfully predicted the composite outcome of major bleeding, thromboembolic complications and death.<\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Apostolakis S, Sullivan RM, Olshansky B, Lip GYH. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23669885\">Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT\u2082R\u2082 score<\/a>. Chest. 2013 Nov;144(5):1555-1563.<\/li>\n<li>\n<div class=\"citation-text\">Lip GYH, Haguenoer K, Saint-Etienne C, Fauchier L. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24722973\/\">Relationship of the SAMe-TT\u2082R\u2082 score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation<\/a>. Chest. 2014 Sep;146(3):719-726.<\/div>\n<\/li>\n<li>Abumuaileq RR, Abu-Assi E, Raposeiras-Roubin S, L\u00f3pez-L\u00f3pez A, Redondo-Di\u00e9guez A, \u00c1lvarez-Iglesias D, Rodr\u00edguez-Ma\u00f1ero M, Pe\u00f1a-Gil C, Gonz\u00e1lez-Juanatey JR. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25662984\/\">Evaluation of SAMe-TT2R2 risk score for predicting the quality of anticoagulation control in a real-world cohort of patients with non-valvular atrial fibrillation on vitamin-K antagonists<\/a>. Europace. 2015 May;17(5):711-7.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>SAMe-TT\u2082R\u2082 score for poor INR control SAMe-TT\u2082R\u2082 score aims at predicting those likely to have poor INR (International Normalized Ratio of Prothrombin Time) control while on vitamin K antagonists [1]. The investigators divided the&nbsp;Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial cohort randomly into a derivation cohort and an internal validation cohort. They used [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":31115,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-31105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cardiology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>SAMe-TT\u2082R\u2082 score for poor INR control - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"description\" content=\"SAMe-TT\u2082R\u2082 score: Sex female, Age &lt; 60 years, Medical history, Treatment (interacting drugs), Tobacco use (doubled), Race (doubled)\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/same-tt\u2082r\u2082-score-for-poor-inr-control\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"SAMe-TT\u2082R\u2082 score for poor INR control - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"SAMe-TT\u2082R\u2082 score: Sex female, Age &lt; 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