SAMe-TT2R2 score, time in therapeutic range, and outcomes in anticoagulated patients with atrial fibrillation

Gallego, Pilar; Roldán, Vanessa; Marin, Francisco; Gálvez, José; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y.H.

doi:10.1016/j.amjmed.2014.05.023

Cited by 124Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

SAMe-TT2R2 score, time in therapeutic range, and outcomes in anticoagulated patients with atrial fibrillation

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Gallego, Pilar, Roldán, Vanessa, Marin, Francisco, Gálvez, José, Valdés, Mariano, Vicente, Vicente, Lip, Gregory Y.H.·2014·The American Journal of Medicine

DOI 10.1016/j.amjmed.2014.05.023

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Abstract

Background Oral anticoagulation is highly effective in preventing stroke and mortality in nonvalvular atrial fibrillation patients. However, the efficacy and safety of vitamin K antagonists (the main oral anticoagulation drug used) strongly depends upon the quantity of anticoagulation control, as reflected by the average percentage of the time in therapeutic range of international normalized ratio 2.0-3.0. An easy, simple prediction of which atrial fibrillation patients are likely to do well on vitamin K antagonists (with good average time in therapeutic range) could guide decision-making between using vitamin K antagonists (eg, warfarin) and non-vitamin K antagonist oral anticoagulants.Methods and results In a consecutive cohort of nonvalvular atrial fibrillation patients attending our anticoagulation clinic, we tested the hypothesis that the new Sex, Race, Medical history, Tobacco use, Race (SAMe-TT2R2) score was a predictor for good average time in therapeutic range, and second, this would translate into adverse events in a "real world" cohort of patients with nonvalvular atrial fibrillation. The incidence of bleeding, adverse cardiovascular events (including stroke/thromboembolism), and mortality during the follow-up was higher with increasing SAMe-TT2R2 score. The SAMe-TT2R2 score was predictive for the composite of all adverse events (hazard ratio 1.32 [95% Confidence Interval 1.17-1.50]; P <.001), adverse cardiovascular events (1.52 [1.28-1.83]; P <.001), and all-cause mortality (1.41 [1.16-1.67]; P = .001). A trend was also observed for major bleeding events (1.23 [0.99-1.53]; P = .059).Conclusion In a "real world" cohort of consecutive patients with nonvalvular atrial fibrillation, a high SAMe-TT2R2 score (reflecting poor anticoagulation control with poor time in therapeutic range) was associated with more bleeding, adverse cardiovascular events, and mortality during follow-up.

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Authors: Gallego, P., Roldán, V., Marin, F., Gálvez, J., Valdés, M., Vicente, V., & Lip, G. Y. H.
Affiliations: Birmingham City Hospital (GB)
Hospital General Universitario Morales Meseguer (ES)
Hospital Universitario Virgen de la Arrixaca (ES)
Corresponding author: Lip, Gregory Y.H.
ORCID: Gallego, Pilar
Roldán, Vanessa
Vicente, Vicente
Lip, Gregory Y.H.
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 2014-11
Volume: 127
Issue: 11
Pages: 1083-1088
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/j.amjmed.2014.05.023
OpenAlex: W2046171256
Cited by: 124
References: 15
Citations by year: 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 6 · 2018: 14 · 2017: 17 · 2016: 30 · 2015: 32 · 2014: 3
FWCI: 18.75
Type: journal article
Language: en
Open access: green
research.birmingham.ac.uk
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders: Spanish Foundation Alfonso Martín Escudero
Bayer
Bristol-Myers Squibb
Boehringer Ingelheim
Boston Scientifics
AstraZeneca
Daiichi-Sankyo
Astellas
Sanofi-Aventis
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords: non-valvular atrial fibrillation, oral anticoagulation, vitamin K antagonists, warfarin, SAMe-TT2R2 score, time in therapeutic range, international normalized ratio, anticoagulation management, bleeding risk, all-cause mortality, cardiovascular adverse events, risk prediction
MeSH terms: Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Female, Follow-Up Studies, Hemorrhage, Humans, Male, Sex Factors, Thromboembolism, Vitamin K, Cohort Studies, Proportional Hazards Models, Risk Assessment, International Normalized Ratio, Stroke, Racial Groups, Tobacco Use

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SAMe-TT2R2 score, time in therapeutic range, and outcomes in anticoagulated patients with atrial fibrillation

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