The SAMe-TT2R2 score and quality of anticoagulation in atrial fibrillation:a simple aid to decision-making on who is suitable (or not) for vitamin K antagonists

This editorial refers to ‘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’ by M. R.R.-Y. Abumuaileq et al. , doi:10.1093/europace/euu353. Maintaining the therapeutic range in patients treated with vitamin K antagonists (VKAs) had always been challenging whilst the potential consequences of deviating from the optimal average time in therapeutic range(TTR) are deleterious in patients with atrial fibrillation (AF), given the risk for thromboembolic and bleeding events.1,2 Various clinical decision-making tools have been developed to help decision-making in the management of AF patients. In 2013, a new score—with the acronym SAMe-TT2R2—was proposed to help identify those patients who were likely to have a propensity to poor INR control (as reflected by average time in the therapeutic range [TTR] 2).3 This score was derived from a trial cohort and thus independent validation in ‘real-world’ AF cohorts would be needed. In the current issue of EP-Europace , Abumaileq et al. 4 performed a retrospective analysis of a cohort of outpatients with non-valvular AF and found that SAMe-TT2R2 could indeed represented a useful clinical tool to identify a poor quality of anticoagulation control with VKAs. The predictive ability of SAMe-TT2R2 was acceptable for identifying low TTR and improved when integrated with other clinical characteristics. A strong relationship …